Provider Demographics
NPI:1063436137
Name:BURKE, LINDA ELLEN (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ELLEN
Last Name:BURKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CENTRE ST
Mailing Address - Street 2:SCHOOLHOUSE #202B
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1400
Mailing Address - Country:US
Mailing Address - Phone:617-869-5502
Mailing Address - Fax:
Practice Address - Street 1:130 CENTRE ST
Practice Address - Street 2:SCHOOLHOUSE #202B
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1400
Practice Address - Country:US
Practice Address - Phone:617-869-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY8193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health