Provider Demographics
NPI:1407913221
Name:BURKART, JOSEPH A JR (PSYD LCPC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:BURKART
Suffix:JR
Gender:M
Credentials:PSYD LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO B 131
Mailing Address - Street 2:OLD GOULDSBORO CLINIC
Mailing Address - City:GOULDSBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04607
Mailing Address - Country:US
Mailing Address - Phone:207-963-7531
Mailing Address - Fax:
Practice Address - Street 1:CLINIC RD
Practice Address - Street 2:OLD GOULDSBORO CLINIC
Practice Address - City:GOULDSBORO
Practice Address - State:ME
Practice Address - Zip Code:04607
Practice Address - Country:US
Practice Address - Phone:207-963-7531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional