Provider Demographics
NPI:1508122847
Name:BURKE, KRISTIN R
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
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 1:420 WAKEBY RD
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1706
Mailing Address - Country:US
Mailing Address - Phone:617-650-0717
Mailing Address - Fax:
Practice Address - Street 1:7 MATHAURS ST
Practice Address - Street 2:2
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-4609
Practice Address - Country:US
Practice Address - Phone:617-650-0717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health