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General NPI Number Information
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NPI Number | 1134268584
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Entity Type | Individual
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Provider Name | MINDY ELLEN BURSTEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 11700 N 58TH ST STE F
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-1666
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Country | US
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Telephone | 813-988-6981
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Fax | 813-988-6983
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Provider Business Mailing Address
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Address Line | 11700 N 58TH ST STE F
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-1666
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Country | US
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Telephone | 813-988-6981
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Fax | 813-988-6983
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW2986
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License Number State | FL
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