Provider Demographics
NPI:1801045489
Name:BURGESS, JOSEPH LEROY (BA, MSW, CPS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEROY
Last Name:BURGESS
Suffix:
Gender:
Credentials:BA, MSW, CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 TOLLGATE RUN
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-7202
Mailing Address - Country:US
Mailing Address - Phone:724-366-6132
Mailing Address - Fax:
Practice Address - Street 1:95 E HIGH ST STE 407
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1853
Practice Address - Country:US
Practice Address - Phone:724-366-6132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA328834A336348OtherVALUE BEHAVIORAL HEALTH
PA1007288440051Medicaid