Healthcare Provider Details

I. General information

NPI: 1164561437
Provider Name (Legal Business Name): GLORIA L. BURDETT M.S., PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLORIA E. SHAPIRO M.S., A.P.R.N.

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 FRIEND ST. ELDER SERVICE PLAN OF THE NORTH SHORE
LYNN MA
01902
US

IV. Provider business mailing address

37 FRIEND ST. ELDER SERVICE PLAN OF THE NORTH SHORE
LYNN MA
01902
US

V. Phone/Fax

Practice location:
  • Phone: 781-715-6608
  • Fax: 781-715-6699
Mailing address:
  • Phone: 781-715-6608
  • Fax: 781-715-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number052943-23-08
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number052943-23
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN100851
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: