Individual
PHYLLIS JEAN BURSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
7501 ELMORE LANE, BETHESDA, MD 20817
(301) 229-9224
Mailing address
7501 ELMORE LANE, BETHESDA, MD 20817
(301) 229-9224
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1075
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216241500
—
MD
01
—
A910MEMBER0001
CARE FIRST BCBS NCA
—
Enumeration date
05/23/2007
Last updated
08/21/2012
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