Provider Demographics
NPI:1588160246
Name:BURGESS, CYNTHIA ROBINSON (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ROBINSON
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4178 ROXBURY MILL RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21738-9303
Mailing Address - Country:US
Mailing Address - Phone:240-472-5749
Mailing Address - Fax:
Practice Address - Street 1:18 EXECUTIVE PARK CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2645
Practice Address - Country:US
Practice Address - Phone:301-428-3557
Practice Address - Fax:301-972-6635
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty