Individual
JENNIFER BURDISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3 NORTON AVE, PORT JEFFERSON STATION, NY 11776-4402
(631) 831-6988
Mailing address
3 NORTON AVE, PORT JEFFERSON STATION, NY 11776-4402
(631) 831-6988
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-24856
NY
251S00000X
Community/Behavioral Health Agency
742427131
NY
251S00000X
Community/Behavioral Health Agency
926923151
NY
Other
Enumeration date
09/29/2016
Last updated
03/03/2017
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