Basic Information
Provider Information
NPI: 1316229370
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURNETT
FirstName: BRIDGET
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PSY.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 110429
Address2:  
City: AURORA
State: CO
PostalCode: 800420429
CountryCode: US
TelephoneNumber: 7207771234
FaxNumber:  
Practice Location
Address1: 12605 E. 16TH AVENUE
Address2: UNIVERSITY OF COLORADO HOSPITAL
City: AURORA
State: CO
PostalCode: 800452545
CountryCode: US
TelephoneNumber: 7207771234
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/15/2011
LastUpdateDate: 05/06/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC2200XPSY3520COY Behavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent

No ID Information.


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