Provider Demographics
NPI:1508072109
Name:BURKE, A. JANINE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:A.
Middle Name:JANINE
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 DON GASPAR AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2660
Mailing Address - Country:US
Mailing Address - Phone:505-983-8001
Mailing Address - Fax:
Practice Address - Street 1:1925 ASPEN DR
Practice Address - Street 2:302 A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5459
Practice Address - Country:US
Practice Address - Phone:505-983-8001
Practice Address - Fax:505-983-3061
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0073981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24928330Medicaid