MEDICARE: JENNIFER LYNN BURGIN LCSW, LCAS, CEDS

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	1041C0700X	Clinical Social Worker	C011042	NC

General Provider Information

NPI Number	:	1649669763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN BURGIN LCSW, LCAS, CEDS

Provider Business Mailing Address
First Line	:	3277 ANGELICA ST
Second Line	:
City	:	COCOA
State	:	FL
Zip	:	32926-3671
Country	:	US
Telephone Number	:	910-545-0066
Fax Number	:

Provider Business Practice Location Address
First Line	:	3277 ANGELICA ST
Second Line	:
City	:	COCOA
State	:	FL
Zip	:	32926-3671
Country	:	US
Telephone Number	:	910-545-0066
Fax Number	:

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

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	01/31/2024

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