Provider Demographics
NPI:1194936336
Name:BURNHAM, PATRICIA ANNE (MA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:BURNHAM
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 1:5000 OVERLAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4995
Mailing Address - Country:US
Mailing Address - Phone:310-738-3145
Mailing Address - Fax:
Practice Address - Street 1:5000 OVERLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4995
Practice Address - Country:US
Practice Address - Phone:310-738-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist