Provider Demographics
NPI:1134327216
Name:BURKE, JAMIE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:M
Last Name:BURKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:320 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5340
Practice Address - Country:US
Practice Address - Phone:508-427-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical