Healthcare Provider Details

I. General information

NPI: 1144335720
Provider Name (Legal Business Name): CAMILLE F BURNS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 TERRACE ST
HAWORTH NJ
07641
US

IV. Provider business mailing address

205 PINE STREET
HAWORTH NJ
07641
US

V. Phone/Fax

Practice location:
  • Phone: 201-387-0346
  • Fax:
Mailing address:
  • Phone: 201-387-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1794
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: