Provider Demographics
NPI:1447355979
Name:BURGMAN, REBECCA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:J
Last Name:BURGMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:BURGMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:903 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626
Mailing Address - Country:US
Mailing Address - Phone:512-930-8014
Mailing Address - Fax:512-930-8014
Practice Address - Street 1:903 FOREST ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626
Practice Address - Country:US
Practice Address - Phone:512-930-8014
Practice Address - Fax:512-930-8014
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX278241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S72VMedicare ID - Type Unspecified