Provider Demographics
NPI:1306573399
Name:BURTON, DAMIEN CHRISTIAN
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:CHRISTIAN
Last Name:BURTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53B N LECATO AVE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1030
Mailing Address - Country:US
Mailing Address - Phone:856-723-3453
Mailing Address - Fax:
Practice Address - Street 1:53B N LECATO AVE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1030
Practice Address - Country:US
Practice Address - Phone:856-723-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-22059867103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst