MEDICARE: JEIMI BURGOS LCMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	096352	NY

General Provider Information

NPI Number	:	1033728928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEIMI BURGOS LCMSW

Provider Business Mailing Address
First Line	:	557 GRAND CONCOURSE STE 6015
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5253
Country	:	US
Telephone Number	:	516-696-4467
Fax Number	:

Provider Business Practice Location Address
First Line	:	557 GRAND CONCOURSE STE 6015
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5253
Country	:	US
Telephone Number	:	917-446-9153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	09/01/2021

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Directions to “ JEIMI BURGOS LCMSW” Practice Location

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