Provider Demographics
NPI:1154467785
Name:BURK, ELIZABETH ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:BURK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BROADWAY APT 6D
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5303
Mailing Address - Country:US
Mailing Address - Phone:914-909-0379
Mailing Address - Fax:
Practice Address - Street 1:345 KEAR ST
Practice Address - Street 2:SUITE 202
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4425
Practice Address - Country:US
Practice Address - Phone:914-962-2002
Practice Address - Fax:914-962-0618
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006569103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV43421Medicare ID - Type Unspecified