Provider Demographics
NPI:1407373988
Name:BURNSTEIN, JAMIE (MALLP)
Entity type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:BURNSTEIN
Suffix:
Gender:M
Credentials:MALLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 W DRAYTON ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2727
Mailing Address - Country:US
Mailing Address - Phone:248-891-1490
Mailing Address - Fax:
Practice Address - Street 1:43157 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1955
Practice Address - Country:US
Practice Address - Phone:586-997-9619
Practice Address - Fax:586-997-9635
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012071103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical