Provider Demographics
NPI:1992127815
Name:BURKE, LAURA I (MA)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:I
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEETING HOUSE HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FRANKLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06254-1309
Mailing Address - Country:US
Mailing Address - Phone:860-965-6459
Mailing Address - Fax:
Practice Address - Street 1:10 MEETING HOUSE HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH FRANKLIN
Practice Address - State:CT
Practice Address - Zip Code:06254
Practice Address - Country:US
Practice Address - Phone:860-965-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-12
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3085101YM0800X
CT3085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health