Provider Demographics
NPI:1639236052
Name:BUROZSKI-UMLAUF, TINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:BUROZSKI-UMLAUF
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 1:1000 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-1447
Mailing Address - Country:US
Mailing Address - Phone:609-548-2286
Mailing Address - Fax:732-240-2157
Practice Address - Street 1:1000 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-1447
Practice Address - Country:US
Practice Address - Phone:609-548-2286
Practice Address - Fax:732-240-2157
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05260400104100000X
NJ44SC053334001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0097985Medicaid