Provider Demographics
NPI:1760649222
Name:BURGIO, LUISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:
Last Name:BURGIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 GATEWAY BLVD
Mailing Address - Street 2:SUITE # 220
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-7219
Mailing Address - Country:US
Mailing Address - Phone:561-739-7952
Mailing Address - Fax:
Practice Address - Street 1:1500 GATEWAY BLVD
Practice Address - Street 2:SUITE # 220
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7219
Practice Address - Country:US
Practice Address - Phone:561-739-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7509103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical