Healthcare Provider Details

I. General information

NPI: 1073671558
Provider Name (Legal Business Name): SUSAN FLORA-BURNETT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 BROADWAY AVE
YOUNGSTOWN OH
44504-1752
US

IV. Provider business mailing address

535 MARMION AVE
YOUNGSTOWN OH
44502-2323
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-9275
  • Fax:
Mailing address:
  • Phone: 330-782-5664
  • Fax: 330-782-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.170232
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberS0019700
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: