Healthcare Provider Details

I. General information

NPI: 1629589726
Provider Name (Legal Business Name): EZEKIAH REIS BURGIN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EZEKIEL REIS BURGIN LICSW

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 ORCHARD ST
NORTHAMPTON MA
01060-2324
US

IV. Provider business mailing address

37 ORCHARD ST
NORTHAMPTON MA
01060-2324
US

V. Phone/Fax

Practice location:
  • Phone: 413-569-8124
  • Fax:
Mailing address:
  • Phone: 413-569-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124825
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: