Basic Information
| Provider Information | |||||||||
| NPI: | 1467822916 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRESSLEY-BURGIN | ||||||||
| FirstName: | JENNISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13000 BRUCE B DOWNS BLVD BLDG 38 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336124745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134610543 | ||||||||
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| Practice Location | |||||||||
| Address1: | 151 KNOLLCROFT RD BLDG 53 | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079395001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086470180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2015 | ||||||||
| LastUpdateDate: | 04/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW15838 | FL | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 44SL05344000 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.