1033276563 NPI number — MRS. KENDRA L BURKE LCSW

Table of content: MRS. KENDRA L BURKE LCSW (NPI 1033276563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033276563 NPI number — MRS. KENDRA L BURKE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKE
Provider First Name:
KENDRA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033276563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 PROSPECT ST
Provider Second Line Business Mailing Address:
APT 1
Provider Business Mailing Address City Name:
ROCKLAND
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02370-2417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-871-6576
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 TEMPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-5110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-471-8400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  213327 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 213327 . This is a "SOCIAL WORK LICENCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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