MEDICARE: BARBARA BURRELL 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	000663	CT

General Provider Information

NPI Number	:	1669513511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA BURRELL LCSW

Provider Business Mailing Address
First Line	:	374 AUGUSTA DR
Second Line	:
City	:	ORANGE
State	:	CT
Zip	:	06477-2716
Country	:	US
Telephone Number	:	203-795-5933
Fax Number	:	203-877-8053

Provider Business Practice Location Address
First Line	:	57 PLAINS RD
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06461-2573
Country	:	US
Telephone Number	:	203-877-1766
Fax Number	:	203-605-6755

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/09/2014

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