Healthcare Provider Details

I. General information

NPI: 1790265221
Provider Name (Legal Business Name): NATASHA A. M. BURTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date: 05/10/2022
Reactivation Date: 12/04/2025

III. Provider practice location address

125 GLENRIDGE AVE UNIT 1130
MONTCLAIR NJ
07042-6843
US

IV. Provider business mailing address

125 GLENRIDGE AVE UNIT 1130
MONTCLAIR NJ
07042-6843
US

V. Phone/Fax

Practice location:
  • Phone: 347-669-1227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number095313-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06420000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: