Provider Demographics
NPI:1679820468
Name:BURGESS-CARTER, PRISCILLA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:BURGESS-CARTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:BURGESS-SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:1041 45TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2402
Mailing Address - Country:US
Mailing Address - Phone:561-383-5721
Mailing Address - Fax:561-383-5922
Practice Address - Street 1:1041 45TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2402
Practice Address - Country:US
Practice Address - Phone:561-383-5721
Practice Address - Fax:561-383-5922
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW68821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLISW6882OtherREGISTERED CLINICAL SOCIAL WORKER INTERN LICENSE