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General NPI Number Information
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NPI Number | 1588141469
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Entity Type | Individual
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Provider Name | TIA E BURGESS LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 6729 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-7063
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Country | US
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Telephone | 187-456-7001
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Fax |
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Provider Business Mailing Address
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Address Line | 405 DUMONT AVE APT 11U
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City | BROOKLYN
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State | NY
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Zip | 11212-7394
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Country | US
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Telephone | 917-753-5494
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 119651
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License Number State | NY
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