Provider Demographics
NPI:1578658209
Name:BURLEW, KAREN RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RUTH
Last Name:BURLEW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:RUTH
Other - Last Name:SZYMANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 W SENECA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-273-0945
Mailing Address - Fax:607-657-8454
Practice Address - Street 1:103 W SENECA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-273-0945
Practice Address - Fax:607-657-8454
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0259321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53861BMedicare ID - Type Unspecified