Healthcare Provider Details

I. General information

NPI: 1497812713
Provider Name (Legal Business Name): BURT ALLEN PRICE MSW,LGSW,CCAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 LEONARD AVE
FAIRMONT WV
26554-3843
US

IV. Provider business mailing address

494 LYNCH RD
MORGANTOWN WV
26501-7787
US

V. Phone/Fax

Practice location:
  • Phone: 304-366-7174
  • Fax: 304-366-7419
Mailing address:
  • Phone: 304-366-7174
  • Fax: 304-366-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBP00938488
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: