Provider Demographics
NPI:1114083110
Name:BURKE, PHILIP L (MS,SW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:L
Last Name:BURKE
Suffix:
Gender:M
Credentials:MS,SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 STATION RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4434
Mailing Address - Country:US
Mailing Address - Phone:978-767-0393
Mailing Address - Fax:
Practice Address - Street 1:34 SUMMER STREET
Practice Address - Street 2:FITZGERALD & ASSOCIATES
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-744-8608
Practice Address - Fax:978-741-3702
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Not Answered171000000XOther Service ProvidersMilitary Health Care Provider