MEDICARE: MONICA BURGOS LMSW

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	101YM0800X	Mental Health Counselor	LG50083678	DC

General Provider Information

NPI Number	:	1952074148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA BURGOS LMSW

Provider Business Mailing Address
First Line	:	2612 LADY GROVE RD
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-4118
Country	:	US
Telephone Number	:	202-351-1589
Fax Number	:

Provider Business Practice Location Address
First Line	:	2612 LADY GROVE RD
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-4118
Country	:	US
Telephone Number	:	202-351-1589
Fax Number	:

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

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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