MEDICARE: JANE BURBANK L.C.S.W. R.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	069313	NY

General Provider Information

NPI Number	:	1225114523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE BURBANK L.C.S.W. R.

Provider Business Mailing Address
First Line	:	2500 JOHNSON AVE APT 20J
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4946
Country	:	US
Telephone Number	:	917-733-4094
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 JOHNSON AVE APT 20J
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4946
Country	:	US
Telephone Number	:	917-733-4094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2006
Last Update Date	:	07/24/2025

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