Provider Demographics
NPI:1124377254
Name:BURK, JUDITH REISZ (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:REISZ
Last Name:BURK
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 1:684 ASHBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-7394
Mailing Address - Country:US
Mailing Address - Phone:502-682-7647
Mailing Address - Fax:
Practice Address - Street 1:544 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1120
Practice Address - Country:US
Practice Address - Phone:502-682-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLCSW 01031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical