Provider Demographics
NPI:1144702481
Name:BURKE, CARRE (LICSW)
Entity type:Individual
Prefix:
First Name:CARRE
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CONGRESS ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2010
Mailing Address - Country:US
Mailing Address - Phone:617-209-5518
Mailing Address - Fax:
Practice Address - Street 1:1 CONGRESS ST STE 102
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2010
Practice Address - Country:US
Practice Address - Phone:617-209-5518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1735141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical