MEDICARE: PATRICIA ELLEN BURGIN MFT

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	106H00000X	Marriage & Family Therapist	LF00001172	WA

General Provider Information

NPI Number	:	1962559922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ELLEN BURGIN MFT

Provider Business Mailing Address
First Line	:	PO BOX 31546
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-1546
Country	:	US
Telephone Number	:	206-412-6224
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 1 2 TENTH AVE EAST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102
Country	:	US
Telephone Number	:	206-412-6224
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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