Healthcare Provider Details

I. General information

NPI: 1245855972
Provider Name (Legal Business Name): JOSHUA D. BURGESS LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 NORTON AVE
CLINTON NY
13323-1321
US

IV. Provider business mailing address

63 NORTON AVE
CLINTON NY
13323-1321
US

V. Phone/Fax

Practice location:
  • Phone: 315-795-4321
  • Fax:
Mailing address:
  • Phone: 315-424-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELE REDMOND
Title or Position: BILLING MANAGER
Credential:
Phone: 315-207-4222