Provider Demographics
NPI:1104036607
Name:BURGER, LEWIS RUSSELL JR (LCSW)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:RUSSELL
Last Name:BURGER
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 APRICOT TRL
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6478
Mailing Address - Country:US
Mailing Address - Phone:540-354-4708
Mailing Address - Fax:540-344-0793
Practice Address - Street 1:1026 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4402
Practice Address - Country:US
Practice Address - Phone:540-344-4600
Practice Address - Fax:540-344-0793
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040062571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical