Provider Demographics
NPI:1548069065
Name:BURITICA, SANDRA MILENA (MA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MILENA
Last Name:BURITICA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-6243
Mailing Address - Country:US
Mailing Address - Phone:201-686-1985
Mailing Address - Fax:
Practice Address - Street 1:273 HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-6243
Practice Address - Country:US
Practice Address - Phone:201-686-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00793800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health