Healthcare Provider Details

I. General information

NPI: 1407393291
Provider Name (Legal Business Name): SARA BURDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 MOUNTAIN RD STE. 202
PASADENA MD
21122-7203
US

IV. Provider business mailing address

2528 MOUNTAIN RD STE. 202
PASADENA MD
21122-7203
US

V. Phone/Fax

Practice location:
  • Phone: 410-456-7404
  • Fax: 410-360-1675
Mailing address:
  • Phone: 410-456-7404
  • Fax: 410-360-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: