Provider Demographics
NPI:1932270899
Name:BURGESS, MORGAN D
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:D
Last Name:BURGESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHE
Other - Middle Name:D
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7621 CHASTA RD FL 32976
Mailing Address - Street 2:
Mailing Address - City:MICCO
Mailing Address - State:FL
Mailing Address - Zip Code:32976-7796
Mailing Address - Country:US
Mailing Address - Phone:732-551-6396
Mailing Address - Fax:
Practice Address - Street 1:7621 CHASTA RD FL 32976
Practice Address - Street 2:
Practice Address - City:MICCO
Practice Address - State:FL
Practice Address - Zip Code:32976-7796
Practice Address - Country:US
Practice Address - Phone:732-551-6396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053078001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical