Provider Demographics
NPI:1285845974
Name:BURROUGHS, JAMEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMEL
Middle Name:
Last Name:BURROUGHS
Suffix:
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 1:3250 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4500
Mailing Address - Country:US
Mailing Address - Phone:907-533-1083
Mailing Address - Fax:718-484-2393
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:SUITE 200B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:907-533-1083
Practice Address - Fax:718-484-2393
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0698031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical