Provider Demographics
NPI:1841593829
Name:BURGER, MARIE A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:A
Last Name:BURGER
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 1:130 SYRACUSE ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-5430
Mailing Address - Country:US
Mailing Address - Phone:716-694-6805
Mailing Address - Fax:716-694-5897
Practice Address - Street 1:130 SYRACUSE ST.
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150
Practice Address - Country:US
Practice Address - Phone:716-694-6805
Practice Address - Fax:716-694-5897
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071539-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical