Provider Demographics
NPI:1295001980
Name:BURGOS, BARBARA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BURGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3419
Mailing Address - Country:US
Mailing Address - Phone:484-599-2369
Mailing Address - Fax:610-678-9636
Practice Address - Street 1:2209 QUARRY DR
Practice Address - Street 2:SUITE B-23
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19609-1155
Practice Address - Country:US
Practice Address - Phone:610-678-9949
Practice Address - Fax:610-678-9636
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076441Medicare UPIN