Individual
JENICE BURGOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
760 BROADWAY # 5A206, BROOKLYN, NY 11206-5383
(718) 963-5893
(718) 630-3138
Mailing address
1450 GATES AVE APT 1R, BROOKLYN, NY 11237-5669
(347) 553-6798
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
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