Healthcare Provider Details

I. General information

NPI: 1205326196
Provider Name (Legal Business Name): JAY WESLEY BURROWS MSW, LCSW, CADC, CCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 RICHMOND ST
ERIE PA
16509-1978
US

IV. Provider business mailing address

3678 DOGLEG TRL
ERIE PA
16510-5964
US

V. Phone/Fax

Practice location:
  • Phone: 814-864-4226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018779
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: