Healthcare Provider Details

I. General information

NPI: 1447082466
Provider Name (Legal Business Name): CHERYL BURDETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 SIMPSON AVE
NATIONAL PARK NJ
08063-1441
US

IV. Provider business mailing address

48 CANDLEWOOD RD
WILLIAMSTOWN NJ
08094-9134
US

V. Phone/Fax

Practice location:
  • Phone: 856-254-5547
  • Fax:
Mailing address:
  • Phone: 856-254-5547
  • Fax:

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: