Provider Demographics
NPI:1164812152
Name:BURKE, ANTHIA LISIA (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANTHIA
Middle Name:LISIA
Last Name:BURKE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17515 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5503
Mailing Address - Country:US
Mailing Address - Phone:718-632-3275
Mailing Address - Fax:718-632-1568
Practice Address - Street 1:17515 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5503
Practice Address - Country:US
Practice Address - Phone:718-632-3275
Practice Address - Fax:718-632-1568
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)