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NPI Code Detail

MEDICARE: ELISIA MARIE BURSE LCSW

MEDICARE: ELISIA MARIE BURSE LCSW
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
11041C0700XClinical Social WorkerSW21781FL

General Provider Information

NPI Number : 1205610177
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISIA MARIE BURSE LCSW
Provider Business Mailing Address
First Line : 2995 DREW ST
Second Line :
City : CLEARWATER
State : FL
Zip : 33759-3012
Country : US
Telephone Number : 727-315-7496
Fax Number :
Provider Business Practice Location Address
First Line : 3503 E FRONTAGE RD
Second Line :
City : TAMPA
State : FL
Zip : 33607-1742
Country : US
Telephone Number : 727-519-1336
Fax Number : 727-333-6213
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2023
Last Update Date : 01/25/2024

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Directions to “ ELISIA MARIE BURSE LCSW” Practice Location

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