Provider Demographics
NPI:1154691459
Name:BURROWS, GERALD A JR (LCPC LADC CCS)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:A
Last Name:BURROWS
Suffix:JR
Gender:M
Credentials:LCPC LADC CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6769
Mailing Address - Country:US
Mailing Address - Phone:207-752-3569
Mailing Address - Fax:
Practice Address - Street 1:90 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6769
Practice Address - Country:US
Practice Address - Phone:207-752-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5211101YA0400X
MECC4266101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional