Provider Demographics
NPI:1437344173
Name:BURKE, LEO JOSEPH III (PSYD, PC)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:JOSEPH
Last Name:BURKE
Suffix:III
Gender:M
Credentials:PSYD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 MAPLE ST # B-3
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5068
Mailing Address - Country:US
Mailing Address - Phone:504-232-7338
Mailing Address - Fax:504-323-1992
Practice Address - Street 1:7611 MAPLE ST # B-3
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5068
Practice Address - Country:US
Practice Address - Phone:504-232-7338
Practice Address - Fax:504-323-1992
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004513101YM0800X, 101YP2500X
LA1375103TC0700X
PAPS017349103TC0700X, 103TC2200X
LA304056103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent