Provider Demographics
NPI:1740537927
Name:BROOKLYN PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:BROOKLYN PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURGIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-522-6517
Mailing Address - Street 1:142 JORALEMON ST
Mailing Address - Street 2:SUITE 9C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4747
Mailing Address - Country:US
Mailing Address - Phone:718-522-6517
Mailing Address - Fax:718-522-3517
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:SUITE 9C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4747
Practice Address - Country:US
Practice Address - Phone:718-522-6517
Practice Address - Fax:718-522-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty