Provider Demographics
NPI:1639659097
Name:BURKE, MOLLY MARIE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARIE
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 1:83 DERRYFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1322
Mailing Address - Country:US
Mailing Address - Phone:413-636-8896
Mailing Address - Fax:
Practice Address - Street 1:83 DERRYFIELD AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1322
Practice Address - Country:US
Practice Address - Phone:413-636-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health