Provider Demographics
NPI:1043556715
Name:BURKE, MARY ANN (MFT)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 UPPER UNION ST
Mailing Address - Street 2:ROOM 101
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2583
Mailing Address - Country:US
Mailing Address - Phone:702-336-1940
Mailing Address - Fax:
Practice Address - Street 1:835 UPPER UNION ST
Practice Address - Street 2:ROOM 101
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2583
Practice Address - Country:US
Practice Address - Phone:702-336-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23860106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist