Healthcare Provider Details

I. General information

NPI: 1932644572
Provider Name (Legal Business Name): HALINA OCHOTA BURNS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8133 ELLIOTT RD SUITE 215
EASTON MD
21601-2945
US

IV. Provider business mailing address

PO BOX 306
SAINT MICHAELS MD
21663-0306
US

V. Phone/Fax

Practice location:
  • Phone: 410-829-1092
  • Fax:
Mailing address:
  • Phone: 410-829-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04741
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number04741
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: