Provider Demographics
NPI:1417483967
Name:BURKE, CASEY LEE (LCAT, ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:LEE
Last Name:BURKE
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 BROADWAY
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3211
Mailing Address - Country:US
Mailing Address - Phone:212-419-1522
Mailing Address - Fax:212-564-1358
Practice Address - Street 1:1270 BROADWAY
Practice Address - Street 2:SUITE 1103
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3211
Practice Address - Country:US
Practice Address - Phone:212-419-1522
Practice Address - Fax:212-564-1358
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001788221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist