Provider Demographics
NPI:1700619665
Name:BURGEON BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:BURGEON BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHIRIFIE
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:860-906-2951
Mailing Address - Street 1:869 MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6052
Mailing Address - Country:US
Mailing Address - Phone:860-906-2951
Mailing Address - Fax:
Practice Address - Street 1:869 MAIN ST APT 3
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6052
Practice Address - Country:US
Practice Address - Phone:860-906-2951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty