Individual
JENICE BURGOS
Active
Individual
JENICE BURGOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
107043
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100148153
—
NY
Enumeration date
08/05/2021
Last updated
08/05/2021
Update your record
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