Provider Demographics
NPI:1164267431
Name:BURDA-WOOD, MICHELLE L (PRE-LIC PC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BURDA-WOOD
Suffix:
Gender:F
Credentials:PRE-LIC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2417
Mailing Address - Country:US
Mailing Address - Phone:267-597-7679
Mailing Address - Fax:
Practice Address - Street 1:1206 OHIO AVE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-2417
Practice Address - Country:US
Practice Address - Phone:267-597-7679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health