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General NPI Number Information
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NPI Number | 1467899427
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Entity Type | Individual
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Provider Name | SOFIA BURGESS LICSW
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Gender | Female
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Dates
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Enumeration Date | 05/31/2013
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 780 AMERICAN LEGION HWY
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City | ROSLINDALE
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State | MA
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Zip | 02131-3908
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Country | US
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Telephone | 617-285-4541
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Fax | 617-774-1490
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Provider Business Mailing Address
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Address Line | 780 AMERICAN LEGION HWY
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City | ROSLINDALE
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State | MA
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Zip | 02131-3908
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Country | US
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Telephone | 617-285-4541
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Fax | 617-774-1490
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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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 | 000121718
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License Number State | MA
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