Provider Demographics
NPI:1366517567
Name:BURGESS, VIRGINIA (MSW)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 FLOURNOY CIR E UNIT 5410
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-1425
Mailing Address - Country:US
Mailing Address - Phone:860-917-3718
Mailing Address - Fax:
Practice Address - Street 1:2525 PASADENA AVE S STE M
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4556
Practice Address - Country:US
Practice Address - Phone:727-254-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL157981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical