1770516858 NPI number — MRS. KATHRYN BURKE IMIRIE LCSWC

Table of content: MRS. KATHRYN BURKE IMIRIE LCSWC (NPI 1770516858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770516858 NPI number — MRS. KATHRYN BURKE IMIRIE LCSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IMIRIE
Provider First Name:
KATHRYN
Provider Middle Name:
BURKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURKE
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770516858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17041 BULLFROG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMMITSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21727-8732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-471-2585
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10926 SIMMONS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMITSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21727-8400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-471-2585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2006

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:  09866 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 698800800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".