Basic Information
| Provider Information | |||||||||
| NPI: | 1003150137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURT | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 338 PLEASANT PINES AVE | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026321427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086482084 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 314 OCEAN ST | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026014739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086482084 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1019725 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.