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General NPI Number Information
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NPI Number | 1740537927
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Entity Type | Organization
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Legal Business Name | BROOKLYN PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 142 JORALEMON ST SUITE 9C
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City | BROOKLYN
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State | NY
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Zip | 11201-4747
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Country | US
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Telephone | 718-522-6517
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Fax | 718-522-3517
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Provider Business Mailing Address
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Address Line | 142 JORALEMON ST SUITE 9C
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City | BROOKLYN
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State | NY
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Zip | 11201-4747
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Country | US
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Telephone | 718-522-6517
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Fax | 718-522-3517
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. MARIA R. BURGIO
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Credential | PHD
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Telephone | 718-522-6517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 010697
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License Number State | NY
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