MEDICARE: RAVEN M BURRELL

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	101Y00000X	Counselor	LMHC10003419	MA

General Provider Information

NPI Number	:	1376158071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN M BURRELL

Provider Business Mailing Address
First Line	:	359 FENN ST
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-5261
Country	:	US
Telephone Number	:	413-499-0412
Fax Number	:	413-448-2198

Provider Business Practice Location Address
First Line	:	125 WESTGATE CENTER DR # 1063
Second Line	:
City	:	HADLEY
State	:	MA
Zip	:	01035-9588
Country	:	US
Telephone Number	:	413-282-8782
Fax Number	:	413-496-7031

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	04/04/2025

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Directions to “ RAVEN M BURRELL ” Practice Location

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