Provider Demographics
| NPI: | 1407925167 |
|---|---|
| Name: | BURG, LAURA J (LCSW) |
| Entity Type: | Individual |
| Prefix: | MS |
| First Name: | LAURA |
| Middle Name: | J |
| Last Name: | BURG |
| 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: | 1351 NEWTOWN PIKE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LEXINGTON |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 40511-1217 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 859-253-1686 |
| Mailing Address - Fax: | 859-254-2743 |
| Practice Address - Street 1: | 201 MECHANIC ST |
| Practice Address - Street 2: | |
| Practice Address - City: | LEXINGTON |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 40507-1004 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 859-253-1686 |
| Practice Address - Fax: | 859-254-2743 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2006-11-07 |
| Last Update Date: | 2007-07-09 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| KY | 1164 | 1041C0700X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 30615058 | Medicaid | |
| KY | 0331418 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0331216 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0331316 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0331618 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0332014 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0331923 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0406201 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0452 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 30615058 | Medicaid | |
| KY | 0331820 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0575114 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0045368 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0045478 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0331008 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0338313 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0331523 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0331712 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0331116 | Medicare ID - Type Unspecified | MEDICARE |
| KY | 0332111 | Medicare ID - Type Unspecified | MEDICARE |
