Provider Demographics
NPI:1730713314
Name:BURLINGAME, CARMEN JUNE (MSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:JUNE
Last Name:BURLINGAME
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-2827
Mailing Address - Country:US
Mailing Address - Phone:574-262-3597
Mailing Address - Fax:574-262-3599
Practice Address - Street 1:311 W HIGH ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-2827
Practice Address - Country:US
Practice Address - Phone:574-262-3597
Practice Address - Fax:574-262-3599
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009378A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical