Healthcare Provider Details

I. General information

NPI: 1093588030
Provider Name (Legal Business Name): MERCEDE BURM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 CLINTON AVE S
ROCHESTER NY
14620-1105
US

IV. Provider business mailing address

900 BROWNSVILLE RD
VICTOR NY
14564-9338
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-8422
  • Fax: 585-442-8494
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number38557-T
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: