Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 271 | MT |
N | 103TC0700X | Clinical Psychologist | 271 | MT |
Y | 103G00000X | Clinical Psychologist | PY9803 | FL |
Y | 103TC0700X | Clinical Psychologist | PY9803 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 271 | MT |
N | 103TM1800X | Intellectual & Developmental Disabilities | 271 | MT |
NPI | 1023242898 |
---|---|
Provider Name | Gregory Burns |
First Address | Dunedin, FL 34698-3711 |
Second Address | Dunedin, FL 34698-3711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2009 |
Last Update Date | 16/02/2017 |