Provider Demographics
NPI:1215073002
Name:BURKE, JENNIFER CATHY (LMHC, NCC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CATHY
Last Name:BURKE
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HARWICH RD
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3019
Mailing Address - Country:US
Mailing Address - Phone:413-209-9084
Mailing Address - Fax:
Practice Address - Street 1:230 MAPLE ST STE B1
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5143
Practice Address - Country:US
Practice Address - Phone:413-532-9446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health