Provider Demographics
NPI:1588039374
Name:BURKE, DENISE SHEAKS (LCSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:SHEAKS
Last Name:BURKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:SHEAKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3806 CALLE MAZATLAN
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1927
Mailing Address - Country:US
Mailing Address - Phone:203-675-8135
Mailing Address - Fax:
Practice Address - Street 1:3225 GRANDE VISTA DR
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1193
Practice Address - Country:US
Practice Address - Phone:203-675-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-06
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051471041C0700X
CA696941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical