Provider Demographics
NPI:1073819298
Name:BURKE, THERESA MARIE (MA, PHD, LPC, NCP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA, PHD, LPC, NCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 ROY RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1959
Mailing Address - Country:US
Mailing Address - Phone:610-354-0555
Mailing Address - Fax:610-354-0311
Practice Address - Street 1:743 ROY RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1959
Practice Address - Country:US
Practice Address - Phone:610-354-0555
Practice Address - Fax:610-354-0311
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional