Provider Demographics
NPI:1326045824
Name:BURGESS, JEAN D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:D
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19606 COASTAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-8596
Mailing Address - Country:US
Mailing Address - Phone:301-509-5922
Mailing Address - Fax:302-212-2372
Practice Address - Street 1:19606 COASTAL HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-8596
Practice Address - Country:US
Practice Address - Phone:301-509-5922
Practice Address - Fax:302-212-2372
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD062281041C0700X
DEQ1-00010291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical