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General NPI Number Information
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NPI Number | 1356710131
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Entity Type | Organization
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Legal Business Name | BURROUGHS PSYCHOTHERAPY PRACTICE, LCSW, P.C.
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 26 COURT ST SUITE 2202
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City | BROOKLYN
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State | NY
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Zip | 11242-0103
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Country | US
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Telephone | 646-321-9439
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Fax |
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Provider Business Mailing Address
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Address Line | 26 COURT ST SUITE 2202
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City | BROOKLYN
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State | NY
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Zip | 11242-0103
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Country | US
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Telephone | 646-321-9439
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMEL BURROUGHS
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Credential | LCSW
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Telephone | 917-533-1083
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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 | R069803
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License Number State | NY
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