Provider Demographics
NPI:1275773210
Name:BURKE, CYNTHIA JANE GERTZ (LCSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JANE GERTZ
Last Name:BURKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:COROLLA
Mailing Address - State:NC
Mailing Address - Zip Code:27927-0423
Mailing Address - Country:US
Mailing Address - Phone:757-646-8545
Mailing Address - Fax:
Practice Address - Street 1:863 IVORY CT
Practice Address - Street 2:
Practice Address - City:COROLLA
Practice Address - State:NC
Practice Address - Zip Code:27927
Practice Address - Country:US
Practice Address - Phone:757-646-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040070131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical