Healthcare Provider Details

I. General information

NPI: 1952074148
Provider Name (Legal Business Name): MONICA BURGOS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 LADY GROVE RD
BOWIE MD
20721-4118
US

IV. Provider business mailing address

2612 LADY GROVE RD
BOWIE MD
20721-4118
US

V. Phone/Fax

Practice location:
  • Phone: 202-351-1589
  • Fax:
Mailing address:
  • Phone: 202-351-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32023
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number200004110
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: