Provider Demographics
NPI:1407925167
Name:BURG, LAURA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:BURG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 NEWTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1217
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:859-254-2743
Practice Address - Street 1:201 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1004
Practice Address - Country:US
Practice Address - Phone:859-253-1686
Practice Address - Fax:859-254-2743
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0331418Medicare ID - Type UnspecifiedMEDICARE
KY0331216Medicare ID - Type UnspecifiedMEDICARE
KY0331316Medicare ID - Type UnspecifiedMEDICARE
KY0331618Medicare ID - Type UnspecifiedMEDICARE
KY0332014Medicare ID - Type UnspecifiedMEDICARE
KY0331923Medicare ID - Type UnspecifiedMEDICARE
KY0406201Medicare ID - Type UnspecifiedMEDICARE
KY0452Medicare ID - Type UnspecifiedMEDICARE
KY30615058Medicaid
KY0331820Medicare ID - Type UnspecifiedMEDICARE
KY0575114Medicare ID - Type UnspecifiedMEDICARE
KY0045368Medicare ID - Type UnspecifiedMEDICARE
KY0045478Medicare ID - Type UnspecifiedMEDICARE
KY0331008Medicare ID - Type UnspecifiedMEDICARE
KY0338313Medicare ID - Type UnspecifiedMEDICARE
KY0331523Medicare ID - Type UnspecifiedMEDICARE
KY0331712Medicare ID - Type UnspecifiedMEDICARE
KY0331116Medicare ID - Type UnspecifiedMEDICARE
KY0332111Medicare ID - Type UnspecifiedMEDICARE