Healthcare Provider Details

I. General information

NPI: 1790556231
Provider Name (Legal Business Name): JENNIFER OSEGUERA-BURGIN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SAYRE AVE
PHILLIPSBURG NJ
08865-3326
US

IV. Provider business mailing address

332 GRANT ST
PHILLIPSBURG NJ
08865-3244
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-2074
  • Fax:
Mailing address:
  • Phone: 908-416-0874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00761500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: