Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1019725 | MA |
NPI | 1003150137 |
---|---|
Provider Name | Alan Burt |
First Address | Centerville, MA 02632-1427 |
Second Address | Hyannis, MA 02601-4739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |