Provider Demographics
NPI:1467058479
Name:BURGOS, MARXLENIN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARXLENIN
Middle Name:
Last Name:BURGOS
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 1:39 STRUYK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2232
Mailing Address - Country:US
Mailing Address - Phone:973-830-9720
Mailing Address - Fax:
Practice Address - Street 1:39 STRUYK AVE APT 1
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:NJ
Practice Address - Zip Code:07508-2232
Practice Address - Country:US
Practice Address - Phone:973-830-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059608001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical