Provider Demographics
NPI:1760682991
Name:BURKETT, LAURA LOUISE (MED)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LOUISE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 RED LION RD APT 17D
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1129
Mailing Address - Country:US
Mailing Address - Phone:215-637-0451
Mailing Address - Fax:
Practice Address - Street 1:3200 RED LION RD APT 17D
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1129
Practice Address - Country:US
Practice Address - Phone:215-637-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2023-05-24
Deactivation Date:2015-11-05
Deactivation Code:
Reactivation Date:2023-05-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst