Provider Demographics
NPI:1487338653
Name:BURGESS, LAVONIA M (BSW)
Entity type:Individual
Prefix:MISS
First Name:LAVONIA
Middle Name:M
Last Name:BURGESS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 1ST ST APT 250
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-3185
Mailing Address - Country:US
Mailing Address - Phone:336-406-1010
Mailing Address - Fax:
Practice Address - Street 1:1272 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:STIRLING
Practice Address - State:NJ
Practice Address - Zip Code:07980-1010
Practice Address - Country:US
Practice Address - Phone:908-504-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor