Provider Demographics
NPI:1578269577
Name:BURKE, SAMANTHA KRISTINE
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:KRISTINE
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 1:3436 LEOPARD CT
Mailing Address - Street 2:
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560-6396
Mailing Address - Country:US
Mailing Address - Phone:661-754-2864
Mailing Address - Fax:
Practice Address - Street 1:5558 CALIFORNIA AVE STE 340
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0710
Practice Address - Country:US
Practice Address - Phone:661-326-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician