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Organization
SOUTH ORANGE BLOSSOMS, LLC
Active
Organization
SOUTH ORANGE BLOSSOMS, LLC
Active
Other names
South Orange Blossoms, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BURLESON MSW, LCSW (OWNER/PSYCHOTHERAPIST)
(973) 370-5686
Entity
Organization
Contact information
Practice address
467 SPRINGFIELD AVE STE 205, SUMMIT, NJ 07901-2622
(973) 370-5686
Mailing address
467 SPRINGFIELD AVE STE 205, SUMMIT, NJ 07901-2622
(973) 370-5686
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881983633
NPI TYPE 1
—
Enumeration date
01/07/2019
Last updated
04/13/2021
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