Provider Demographics
NPI:1851149280
Name:BURMAN, TENNILLE (CASAC 2)
Entity type:Individual
Prefix:
First Name:TENNILLE
Middle Name:
Last Name:BURMAN
Suffix:
Gender:F
Credentials:CASAC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 GRAND BLVD STE 17
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5725
Mailing Address - Country:US
Mailing Address - Phone:631-392-0435
Mailing Address - Fax:
Practice Address - Street 1:69 SECOND AVE
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-2409
Practice Address - Country:US
Practice Address - Phone:518-844-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)