Provider Demographics
NPI:1326881160
Name:DR NAEEMA BURGESS PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:DR NAEEMA BURGESS PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL NEUROPSYCHOLOGIST/OW
Authorized Official - Prefix:DR
Authorized Official - First Name:NAEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PSYD, LP
Authorized Official - Phone:336-430-8253
Mailing Address - Street 1:111 N. 3 RD AVE STE 5T
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550
Mailing Address - Country:US
Mailing Address - Phone:336-430-8253
Mailing Address - Fax:347-487-3904
Practice Address - Street 1:6 GRAMATAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3209
Practice Address - Country:US
Practice Address - Phone:347-740-2640
Practice Address - Fax:347-487-3904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIVING HOPE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)