Healthcare Provider Details

I. General information

NPI: 1184381642
Provider Name (Legal Business Name): CHRISTINE A BURROWS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 PARK AVE
WANTAGH NY
11793-3702
US

IV. Provider business mailing address

3408 PARK AVE
WANTAGH NY
11793-3702
US

V. Phone/Fax

Practice location:
  • Phone: 631-949-6464
  • Fax:
Mailing address:
  • Phone: 516-221-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: