Provider Demographics
NPI:1306818422
Name:BURKE, MARY C (ACP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:BURKE
Suffix:
Gender:F
Credentials:ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E JOPPA RD
Mailing Address - Street 2:SUITE PH-6
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3118
Mailing Address - Country:US
Mailing Address - Phone:410-321-6695
Mailing Address - Fax:410-321-8865
Practice Address - Street 1:204 E JOPPA RD
Practice Address - Street 2:SUITE PH-6
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3118
Practice Address - Country:US
Practice Address - Phone:410-321-6695
Practice Address - Fax:410-321-8865
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD023071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ398Medicare PIN