Provider Demographics
NPI:1548576176
Name:BURKE, GLENARD EDWARD SR (LCADCNCACII, CCVS,BA)
Entity Type:Individual
Prefix:MR
First Name:GLENARD
Middle Name:EDWARD
Last Name:BURKE
Suffix:SR
Gender:M
Credentials:LCADCNCACII, CCVS,BA
Other - Prefix:MR
Other - First Name:GLEN
Other - Middle Name:E
Other - Last Name:BURKE
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:LCADC,NCACII,CCVS,BA
Mailing Address - Street 1:185 ROUTE 183
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874
Mailing Address - Country:US
Mailing Address - Phone:973-426-1640
Mailing Address - Fax:973-426-1641
Practice Address - Street 1:185 ROUTE 183
Practice Address - Street 2:
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874
Practice Address - Country:US
Practice Address - Phone:973-426-1640
Practice Address - Fax:973-426-1641
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00128500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)