Provider Demographics
NPI:1205610177
Name:BURSE, ELISIA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:ELISIA
Middle Name:MARIE
Last Name:BURSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELISIA
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS, OVERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:3503 E FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1742
Practice Address - Country:US
Practice Address - Phone:727-519-1336
Practice Address - Fax:727-333-6213
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW217811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical