Healthcare Provider Details

I. General information

NPI: 1114881976
Provider Name (Legal Business Name): HARRISON MATTHEW BURDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E MARKET ST UNIT 1
ORWIGSBURG PA
17961-1906
US

IV. Provider business mailing address

200 E MARKET ST UNIT 1
ORWIGSBURG PA
17961-1906
US

V. Phone/Fax

Practice location:
  • Phone: 646-256-8976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number016787
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: