Healthcare Provider Details

I. General information

NPI: 1043270069
Provider Name (Legal Business Name): BURT DOWNES EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LEWIS AVENUE
GT BARRINGTON MA
01230
US

IV. Provider business mailing address

20 LEWIS AVENUE
GT BARRINGTON MA
01230
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-1845
  • Fax: 413-528-3667
Mailing address:
  • Phone: 413-528-1845
  • Fax: 413-528-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3365
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: