Individual
KEITH WELLMAN BURNS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
474 MAIN STREET, SPRINGVALE, ME 04083
(207) 324-1500
(207) 490-5263
Mailing address
78 ATLANTIC PL, SOUTH PORTLAND, ME 04106-2316
(207) 842-7701
(207) 842-7773
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC7820
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
245780099
—
ME
Enumeration date
08/31/2006
Last updated
09/24/2012
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