=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568748267
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA ANNE BURTON LLMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2011
-----------------------------------------------------
Last Update Date | 10/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2939 RUSSELL ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48207-4825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-203-9770
-----------------------------------------------------
Fax | 888-529-0535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 880 N ADAMS RD UNIT 7
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48009-5663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-203-9770
-----------------------------------------------------
Fax | 888-529-0535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801093034
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------