Provider Demographics
NPI:1275299703
Name:BURKHART, GINA MARIE (SPECIAL EDUCATION)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:GUILFOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 ZENITH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8877
Mailing Address - Country:US
Mailing Address - Phone:631-764-1222
Mailing Address - Fax:
Practice Address - Street 1:49 ZENITH RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8877
Practice Address - Country:US
Practice Address - Phone:631-764-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst