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General NPI Number Information
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NPI Number | 1407050768
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Entity Type | Individual
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Provider Name | MARY MONICA BURTON LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6835 STATE ROAD 54
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6032
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Country | US
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Telephone | 727-815-3204
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Fax |
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Provider Business Mailing Address
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Address Line | 718 12TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33701-1036
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Country | US
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Telephone | 727-479-6737
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 2150
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License Number State | FL
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