Provider Demographics
NPI:1851433791
Name:BURGNER, BRENDA ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELAINE
Last Name:BURGNER
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 1:2418 KENMORE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5924
Mailing Address - Country:US
Mailing Address - Phone:804-852-2311
Mailing Address - Fax:
Practice Address - Street 1:5412 GLENSIDE DR STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3995
Practice Address - Country:US
Practice Address - Phone:804-852-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040051291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical