Provider Demographics
NPI:1902917933
Name:BURDICK, JEANNIE S (MA CLINICAL PSYCH)
Entity Type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:S
Last Name:BURDICK
Suffix:
Gender:F
Credentials:MA CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 BOYCE RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9742
Mailing Address - Country:US
Mailing Address - Phone:585-343-0055
Mailing Address - Fax:
Practice Address - Street 1:8801 BOYCE RD
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-9742
Practice Address - Country:US
Practice Address - Phone:585-343-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001111-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001111-1OtherMENTAL HEALTH COUNSELOR