Provider Demographics
NPI:1922644772
Name:NANCY LYNN BURGOS LCSW PLLC
Entity Type:Organization
Organization Name:NANCY LYNN BURGOS LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-683-6628
Mailing Address - Street 1:9129 120TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3215
Mailing Address - Country:US
Mailing Address - Phone:347-683-6628
Mailing Address - Fax:
Practice Address - Street 1:9129 120TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-3215
Practice Address - Country:US
Practice Address - Phone:347-683-6628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty