Healthcare Provider Details

I. General information

NPI: 1942994108
Provider Name (Legal Business Name): REBECCA MICHELLE BURNS MHRT/C, LMSW-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 MAIN ST
SPRINGVALE ME
04083-1409
US

IV. Provider business mailing address

474 MAIN ST
SPRINGVALE ME
04083-1409
US

V. Phone/Fax

Practice location:
  • Phone: 207-294-2060
  • Fax:
Mailing address:
  • Phone: 207-294-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC21923
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: