MEDICARE: MS. DANA L BURNETTE 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	SW5986	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW5986	OTHER	FL	STATE OF FLORIDA

General Provider Information

NPI Number	:	1598992844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA L BURNETTE LCSW

Provider Business Mailing Address
First Line	:	2320 3RD ST S STE 300
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4058
Country	:	US
Telephone Number	:	904-545-3239
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 3RD ST S STE 300
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4058
Country	:	US
Telephone Number	:	904-545-3239
Fax Number	:

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

Provider Enumeration Date	:	06/14/2009
Last Update Date	:	10/04/2011

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