Healthcare Provider Details

I. General information

NPI: 1174436331
Provider Name (Legal Business Name): TODD MICHAEL BURNS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MAIN ST
UTICA NY
13501-1236
US

IV. Provider business mailing address

330 MAIN ST APT 208
UTICA NY
13501-1215
US

V. Phone/Fax

Practice location:
  • Phone: 315-792-9039
  • Fax:
Mailing address:
  • Phone: 315-794-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121703
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: