MEDICARE: KIMBERLY N BURAS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	8887	LA

General Provider Information

NPI Number	:	1063578433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY N BURAS LCSW

Provider Business Mailing Address
First Line	:	1321 N HULLEN ST
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-4037
Country	:	US
Telephone Number	:	504-415-5687
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 METAIRIE RD
Second Line	:	SUITE 2A-203
City	:	METAIRIE
State	:	LA
Zip	:	70005-4050
Country	:	US
Telephone Number	:	504-415-5687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	10/27/2010

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