Provider Demographics
NPI:1366501173
Name:BURKE, KAITLIN ANN
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANN
Last Name:BURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-6100
Mailing Address - Country:US
Mailing Address - Phone:978-697-0456
Mailing Address - Fax:
Practice Address - Street 1:35 CONGRESS ST
Practice Address - Street 2:SUITE 214
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5529
Practice Address - Country:US
Practice Address - Phone:978-542-1951
Practice Address - Fax:978-542-1954
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health