Provider Demographics
NPI:1760112841
Name:BURKE-RAY, LAKENYA
Entity Type:Individual
Prefix:MS
First Name:LAKENYA
Middle Name:
Last Name:BURKE-RAY
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 1:1486 HUNTINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5971
Mailing Address - Country:US
Mailing Address - Phone:415-936-5624
Mailing Address - Fax:
Practice Address - Street 1:1320 MISSION RD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-1214
Practice Address - Country:US
Practice Address - Phone:415-936-5624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist