Provider Demographics
NPI:1992712368
Name:BURNS, SUSAN KATHRYN
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KATHRYN
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GRACELAND DR SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2778
Mailing Address - Country:US
Mailing Address - Phone:505-830-1010
Mailing Address - Fax:505-268-3845
Practice Address - Street 1:301 GRACELAND DR SE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2778
Practice Address - Country:US
Practice Address - Phone:505-830-1010
Practice Address - Fax:505-268-3845
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical