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General NPI Number Information
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NPI Number | 1134615750
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Entity Type | Individual
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Provider Name | MARTIN JOSEPH BURNHAM
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Gender | Male
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 5408 ROLAND AVE
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City | BALTIMORE
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State | MD
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Zip | 21210-1900
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Country | US
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Telephone | 410-864-3629
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Fax |
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Provider Business Mailing Address
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Address Line | 4210 N CHARLES ST APT 5
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City | BALTIMORE
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State | MD
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Zip | 21218-1041
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Country | US
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Telephone | 443-438-6775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC8717
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License Number State | MD
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