Healthcare Provider Details

I. General information

NPI: 1730098914
Provider Name (Legal Business Name): CRISTINA E BURGOS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E MAIN ST
RIVERHEAD NY
11901-2680
US

IV. Provider business mailing address

901 E MAIN ST
RIVERHEAD NY
11901-2680
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-6220
  • Fax: 631-272-1357
Mailing address:
  • Phone: 631-727-6220
  • Fax: 631-272-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number121570-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: