Healthcare Provider Details

I. General information

NPI: 1891613121
Provider Name (Legal Business Name): MICHELLE JAMIE BURNHAM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 YOUNGS RD
DELANSON NY
12053-1705
US

IV. Provider business mailing address

559 YOUNGS RD
DELANSON NY
12053-1705
US

V. Phone/Fax

Practice location:
  • Phone: 518-369-5344
  • Fax:
Mailing address:
  • Phone: 518-369-5344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003526-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: