Provider Demographics
NPI:1699297150
Name:BURKE, ELIZABETH J (BCABA)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:J
Last Name:BURKE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 MISTLETO LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-8749
Mailing Address - Country:US
Mailing Address - Phone:941-426-5252
Mailing Address - Fax:
Practice Address - Street 1:2351 MISTLETO LN
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-8749
Practice Address - Country:US
Practice Address - Phone:941-426-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst