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General NPI Number Information
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NPI Number | 1427699891
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Entity Type | Individual
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Provider Name | ANGELA M BURD LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 2462 ROUTE 54A STE 102
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City | PENN YAN
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State | NY
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Zip | 14527-8836
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Country | US
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Telephone | 315-640-3570
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Fax |
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Provider Business Mailing Address
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Address Line | 2462 ROUTE 54A STE 102
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City | PENN YAN
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State | NY
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Zip | 14527-8836
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Country | US
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Telephone | 315-640-3570
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 107210-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 095810
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License Number State | NY
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