Provider Demographics
NPI:1336790625
Name:BURKE, SEAN J (LPCMH)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:J
Last Name:BURKE
Suffix:
Gender:M
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COMMERCE DR.
Mailing Address - Street 2:BLDG. 100, SUITE 300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2878
Mailing Address - Country:US
Mailing Address - Phone:302-530-1743
Mailing Address - Fax:
Practice Address - Street 1:100 COMMERCE DR.
Practice Address - Street 2:BLDG. 100, SUITE 300
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2878
Practice Address - Country:US
Practice Address - Phone:302-530-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X
DEPC-0011293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1878Medicaid
DECD-0000107Medicaid