Provider Demographics
NPI:1760937395
Name:BURNS, ROBERT T III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:BURNS
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 BROADHOLLOW RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4863
Mailing Address - Country:US
Mailing Address - Phone:631-338-7882
Mailing Address - Fax:
Practice Address - Street 1:275 BROADHOLLOW RD STE 120
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4863
Practice Address - Country:US
Practice Address - Phone:631-338-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0949651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program