Individual
CARLY BURGOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
737 SW PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL 34953-2618
(561) 909-9738
Mailing address
1255 SW MAPLEWOOD DR, PORT SAINT LUCIE, FL 34986-2312
(954) 643-8450
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
2355S0801X
Speech-Language Assistant
Primary
SI6763
FL
Other
Enumeration date
08/02/2021
Last updated
02/10/2026
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