MEDICARE: MR. ANDREW J BURCH JR. 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
1	1041C0700X	Clinical Social Worker	44SC05504500	NJ

General Provider Information

NPI Number	:	1942798558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW J BURCH JR. LCSW

Provider Business Mailing Address
First Line	:	84 COLUMBUS DR
Second Line	:
City	:	FRANKLIN PARK
State	:	NJ
Zip	:	08823-1734
Country	:	US
Telephone Number	:	201-681-7947
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 COLUMBUS DR
Second Line	:
City	:	FRANKLIN PARK
State	:	NJ
Zip	:	08823-1734
Country	:	US
Telephone Number	:	201-681-7947
Fax Number	:

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

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	04/30/2018

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