Provider Demographics
NPI:1912024928
Name:BURKE, MARY K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
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 1:9 TIMBER ROCK TRL
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2260
Mailing Address - Country:US
Mailing Address - Phone:973-218-1776
Mailing Address - Fax:908-522-1995
Practice Address - Street 1:7 UNION PL
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3656
Practice Address - Country:US
Practice Address - Phone:973-218-1776
Practice Address - Fax:908-522-1995
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00001900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health