Provider Demographics
NPI:1114400645
Name:BURKE, MICHAEL JOSPEH (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSPEH
Last Name:BURKE
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-2305
Mailing Address - Country:US
Mailing Address - Phone:781-470-9687
Mailing Address - Fax:
Practice Address - Street 1:220 FORBES RD REAR
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2710
Practice Address - Country:US
Practice Address - Phone:781-794-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1161531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical