Healthcare Provider Details

I. General information

NPI: 1154521318
Provider Name (Legal Business Name): NAEEMA BURGESS PSYD, ABSNP-D, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GRAMATAN AVE STE 202
MOUNT VERNON NY
10550-3209
US

IV. Provider business mailing address

111 N. 3RD AVE., STE. 5T
MOUNT VERNON NY
10550-1377
US

V. Phone/Fax

Practice location:
  • Phone: 347-740-2640
  • Fax: 347-487-3904
Mailing address:
  • Phone: 336-430-8253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number025364
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number025364
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number5267043746
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2160719
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: