Provider Demographics
NPI:1265294698
Name:BURD-TAMDOGAN, IZABEL EDA (MSW-LP)
Entity type:Individual
Prefix:
First Name:IZABEL
Middle Name:EDA
Last Name:BURD-TAMDOGAN
Suffix:
Gender:F
Credentials:MSW-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COLONIAL DR APT A
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1842
Mailing Address - Country:US
Mailing Address - Phone:180-248-8067
Mailing Address - Fax:
Practice Address - Street 1:3780 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5603
Practice Address - Country:US
Practice Address - Phone:845-243-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP126669104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker