Provider Demographics
NPI:1497232862
Name:BURGIN, AMBER DAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:BURGIN
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 1:2870 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0406
Mailing Address - Country:US
Mailing Address - Phone:352-351-9140
Mailing Address - Fax:352-732-3825
Practice Address - Street 1:2870 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0406
Practice Address - Country:US
Practice Address - Phone:352-351-9140
Practice Address - Fax:352-732-3825
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW107951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical