Provider Demographics
NPI:1134697501
Name:BURICK, JANINE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:BURICK
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 1:32486 STATE HIGHWAY 408
Mailing Address - Street 2:
Mailing Address - City:TOWNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16360-3106
Mailing Address - Country:US
Mailing Address - Phone:814-460-9722
Mailing Address - Fax:
Practice Address - Street 1:32486 STATE HIGHWAY 408
Practice Address - Street 2:
Practice Address - City:TOWNVILLE
Practice Address - State:PA
Practice Address - Zip Code:16360-3106
Practice Address - Country:US
Practice Address - Phone:814-460-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0198161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical