Provider Demographics
NPI:1154521318
Name:BURGESS, NAEEMA (PSYD, ABSNP-D, LP)
Entity type:Individual
Prefix:DR
First Name:NAEEMA
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PSYD, ABSNP-D, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N. 3RD AVE., STE. 5T
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1377
Mailing Address - Country:US
Mailing Address - Phone:336-430-8253
Mailing Address - Fax:
Practice Address - Street 1:6 GRAMATAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3209
Practice Address - Country:US
Practice Address - Phone:347-740-2640
Practice Address - Fax:347-487-3904
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025364103T00000X, 103G00000X
CT5267043746103TS0200X
NY2160719103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool