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1811240617 NPI number — ELISSA DEANNE BURDICK MA, NBC-HWC

NPI Number: 1811240617
Health Care Provider/Practitioner: ELISSA DEANNE BURDICK MA, NBC-HWC

Information about “1811240617” NPI (ELISSA DEANNE BURDICK MA, NBC-HWC) exists in 1811240617 in HTML format HTML  |  1811240617 in plain Text format TXT  |  1811240617 in PDF (Portable Document Format) PDF  |  1811240617 in an XML format XML  formats.

NPI Number : 1811240617 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811240617",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BURDICK",
    "FirstName": "ELISSA",
    "MiddleName": "DEANNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA, NBC-HWC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "103 DAVIS ST APT 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENFIELD",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01301-2472",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "413-336-5894",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8 SANDERSON ST FL 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREENFIELD",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "01301-2712",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "413-336-5894",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/18/2012",
    "LastUpdateDate": "10/21/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171400000X",
          "TaxonomyName": "Health & Wellness Coach",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "10005216",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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