Provider Demographics
NPI:1851185664
Name:BURGENSON, CHRISTOPHER DYLAN
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DYLAN
Last Name:BURGENSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5991
Mailing Address - Country:US
Mailing Address - Phone:240-330-4361
Mailing Address - Fax:
Practice Address - Street 1:1 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5991
Practice Address - Country:US
Practice Address - Phone:240-330-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health