Provider Demographics
NPI:1760571756
Name:BURKARD, JEFFRY (LCSW)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:
Last Name:BURKARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JEFFRY
Other - Middle Name:
Other - Last Name:BURKARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:7410 MISSION VALLEY RD
Mailing Address - Street 2:VA HEALTHCARE CLINIC
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4405
Mailing Address - Country:US
Mailing Address - Phone:619-497-8907
Mailing Address - Fax:619-497-8986
Practice Address - Street 1:7410 MISSION VALLEY RD
Practice Address - Street 2:VA HEALTHCARE CLINIC
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4405
Practice Address - Country:US
Practice Address - Phone:619-497-8907
Practice Address - Fax:619-497-8986
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX511401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical