Healthcare Provider Details

I. General information

NPI: 1386973188
Provider Name (Legal Business Name): LEM BURNHAM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218A SUNSET ROAD SCREENING, CRISIS & INTERVENTION PROGRAM (SCIP)
WILLINGBORO NJ
08046-1110
US

IV. Provider business mailing address

109 MUIRFIELD CT
MOORESTOWN NJ
08057-3954
US

V. Phone/Fax

Practice location:
  • Phone: 609-835-6180
  • Fax: 609-835-7962
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: