Provider Demographics
NPI:1609099472
Name:BURKE, AINSLEY KELLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:AINSLEY
Middle Name:KELLER
Last Name:BURKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W 72ND ST
Mailing Address - Street 2:APT 3K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4163
Mailing Address - Country:US
Mailing Address - Phone:917-355-5885
Mailing Address - Fax:
Practice Address - Street 1:118 W 79TH ST
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6445
Practice Address - Country:US
Practice Address - Phone:917-355-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013790103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical