Active NPI
Stephanie Burnham
- Clinical Social Worker
- Putnam, CT
National Provider Identifier
1811772403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 13301
- Practice address
- 202 Pomfret St
Putnam, CT 06260-1833 - Phone
- (860) 963-7917
- Fax
- (860) 963-0018
- NPI assigned
- Aug 30, 2023
- Last updated
- Aug 30, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 13301 | CT | Primary |
Addresses
Primary practice location
202 Pomfret St
Putnam, CT 06260-1833
Mailing address
40 Mansfield Ave
Willimantic, CT 06226-2018
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13301 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693353600000",
"number": "1811772403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 MANSFIELD AVE",
"city": "WILLIMANTIC",
"state": "CT",
"postal_code": "062262018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 POMFRET ST",
"city": "PUTNAM",
"state": "CT",
"postal_code": "062601833",
"telephone_number": "860-963-7917",
"fax_number": "860-963-0018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURNHAM",
"first_name": "STEPHANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-30",
"last_updated": "2023-08-30",
"certification_date": "2023-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "13301",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Putnam, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.