Provider Demographics
NPI:1124597331
Name:DR. JANET BURKE BCBA-D,LBA
Entity Type:Organization
Organization Name:DR. JANET BURKE BCBA-D,LBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DR. JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE BCBA D LBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-826-1125
Mailing Address - Street 1:50 CHARTER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1574
Mailing Address - Country:US
Mailing Address - Phone:914-826-1125
Mailing Address - Fax:
Practice Address - Street 1:50 CHARTER RIDGE DR
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1574
Practice Address - Country:US
Practice Address - Phone:914-826-1125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1336411677Medicaid