Healthcare Provider Details

I. General information

NPI: 1811260615
Provider Name (Legal Business Name): CAMELLIA BERNICE BURTON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 REVOLUTION ST
HAVRE DE GRACE MD
21078-3320
US

IV. Provider business mailing address

719 MARYLAND AVE
YORK PA
17404-3133
US

V. Phone/Fax

Practice location:
  • Phone: 843-364-6610
  • Fax:
Mailing address:
  • Phone: 843-364-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017844
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number16102
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: