Provider Demographics
NPI:1932270899
Name:BURGESS, MORGAN D
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:D
Last Name:BURGESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHE
Other - Middle Name:D
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:20 ASHLEY RD # B
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-3208
Mailing Address - Country:US
Mailing Address - Phone:732-493-8080
Mailing Address - Fax:732-493-8810
Practice Address - Street 1:931 W PARK AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7207
Practice Address - Country:US
Practice Address - Phone:732-493-8080
Practice Address - Fax:732-493-8810
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053078001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical