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General NPI Number Information
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NPI Number | 1326881160
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Entity Type | Organization
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Legal Business Name | DR NAEEMA BURGESS PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 6 GRAMATAN AVE STE 202
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City | MOUNT VERNON
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State | NY
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Zip | 10550-3209
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Country | US
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Telephone | 347-740-2640
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Fax | 347-487-3904
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Provider Business Mailing Address
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Address Line | 111 N. 3 RD AVE STE 5T
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City | MOUNT VERNON
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State | NY
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Zip | 10550
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Country | US
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Telephone | 336-430-8253
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Fax | 347-487-3904
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Authorized Official
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Title or Position | OWNER/CLINICAL NEUROPSYCHOLOGIST/OW
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Name | DR. NAEEMA BURGESS
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Credential | MS, PSYD, LP
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Telephone | 336-430-8253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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Taxonomy #2
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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