Doctor Name: | KEITH WELLMAN BURNS |
NPI Number: | 1295846566 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | LC7820 |
Business Practice Address: | 474 Main Street Springvale, ME - 04083 |
Business Phone Number: | 2073241500 |
Business Fax Number: | 2074905263 |
Mailing Address: | 78 Atlantic Pl, SOUTH PORTLAND |
State: | ME |
Postal Code: | 041062316 |
Phone Number: | 2078427701 |
Fax Number: | 2078427773 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 09/24/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LC7820 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |