Provider Demographics
NPI:1477742898
Name:BURGESS, DAVID D (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:BURGESS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2610
Mailing Address - Country:US
Mailing Address - Phone:303-830-8805
Mailing Address - Fax:303-830-8918
Practice Address - Street 1:709 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2610
Practice Address - Country:US
Practice Address - Phone:303-830-8805
Practice Address - Fax:303-830-8918
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9892451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCA0216Medicare PIN