Provider Demographics
NPI:1538615299
Name:BURDITT, ELLEN (LADC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BURDITT
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MECHANIC ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2420
Mailing Address - Country:US
Mailing Address - Phone:508-792-5400
Mailing Address - Fax:
Practice Address - Street 1:155A OAK STREET
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:800-464-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor