Healthcare Provider Details

I. General information

NPI: 1295001980
Provider Name (Legal Business Name): BARBARA BURGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 QUARRY DR SUITE B-23
READING PA
19609-1155
US

IV. Provider business mailing address

536 WALNUT ST
READING PA
19601-3419
US

V. Phone/Fax

Practice location:
  • Phone: 610-678-9949
  • Fax: 610-678-9636
Mailing address:
  • Phone: 484-599-2369
  • Fax: 610-678-9636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: