Basic Information
| Provider Information | |||||||||
| NPI: | 1558402719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKAMP | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | WALTER | ||||||||
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| Credential: | MA, CADC I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2644 SE 50TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972061536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033131669 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19 WATER ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060732225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035351150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 06/24/2016 | ||||||||
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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 | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.