| J. Randolph Burnham Ph.d.,p.c. | |
|
18 Kings Hwy S Westport CT 06880-4710 | |
| (203) 227-7199 | |
| Not Available |
| Full Name | J. Randolph Burnham Ph.d.,p.c. |
|---|---|
| Speciality | Psychologist |
| Location | 18 Kings Hwy S, Westport, Connecticut |
| Authorized Official Name and Position | J. Randolph Burnham (PRESIDENT) |
| Authorized Official Contact | 2032277199 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J. Randolph Burnham Ph.d.,p.c. 18 Kings Hwy S Westport CT 06880-4710 Ph: (203) 227-7199 | J. Randolph Burnham Ph.d.,p.c. 18 Kings Hwy S Westport CT 06880-4710 Ph: (203) 227-7199 |
| NPI Number | 1992854483 |
|---|---|
| Provider Enumeration Date | 01/10/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5597953703 |
|---|---|
| Medicare Enrollment ID | O20110103000348 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992854483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 464 (Connecticut) | Primary |
| Provider Name | John R Burnham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417005554 PECOS PAC ID: 4284822404 Enrollment ID: I20110103000409 |
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