Provider Demographics
NPI:1003012147
Name:BURKE, SHEILA MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:MARY
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 1:11811 LAURIE CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7903
Mailing Address - Country:US
Mailing Address - Phone:907-350-1323
Mailing Address - Fax:
Practice Address - Street 1:10928 EAGLE RIVER RD STE 108
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8079
Practice Address - Country:US
Practice Address - Phone:907-350-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical