Provider Demographics
NPI:1124450051
Name:VANBURCH, EUGENE
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:VANBURCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 GARRETT A MORGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4510
Mailing Address - Country:US
Mailing Address - Phone:301-851-9965
Mailing Address - Fax:
Practice Address - Street 1:9701 APOLLO DR STE 100
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4785
Practice Address - Country:US
Practice Address - Phone:301-851-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089453-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical