Provider Demographics
NPI:1386259364
Name:BURKE, STEFANIE NIKOLE (LCSW, MSSW)
Entity type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:NIKOLE
Last Name:BURKE
Suffix:
Gender:F
Credentials:LCSW, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 S LAMAR BLVD APT 1420
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0391
Mailing Address - Country:US
Mailing Address - Phone:512-669-9162
Mailing Address - Fax:
Practice Address - Street 1:8500 N MOPAC EXPY
Practice Address - Street 2:STE 601
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8347
Practice Address - Country:US
Practice Address - Phone:512-270-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical