MEDICARE: MS. JEANNIE S BURDICK M.A. CLINICAL PSYCH

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	101YM0800X	Mental Health Counselor	001111-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001111-1	OTHER	NY	MENTAL HEALTH COUNSELOR

General Provider Information

NPI Number	:	1902917933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNIE S BURDICK M.A. CLINICAL PSYCH

Provider Business Mailing Address
First Line	:	8801 BOYCE RD
Second Line	:
City	:	CORFU
State	:	NY
Zip	:	14036-9742
Country	:	US
Telephone Number	:	585-343-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	8801 BOYCE RD
Second Line	:
City	:	CORFU
State	:	NY
Zip	:	14036-9742
Country	:	US
Telephone Number	:	585-343-0055
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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