Provider Demographics
NPI:1366402927
Name:BURGESS, ROBIN LYNN (MA)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:LYNN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 ANTHONY ST
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914
Mailing Address - Country:US
Mailing Address - Phone:401-434-4242
Mailing Address - Fax:
Practice Address - Street 1:610 WAMPANOAG TR
Practice Address - Street 2:EAST BAY MENTAL HEALTH
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-431-9870
Practice Address - Fax:401-438-1957
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRC53476Medicaid