Provider Demographics
NPI:1871503367
Name:BURKE, TRICIA (LCSW-C LCSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:LCSW-C LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 SAINT GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5039
Mailing Address - Country:US
Mailing Address - Phone:808-341-4742
Mailing Address - Fax:
Practice Address - Street 1:1187 SAINT GEORGE DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5039
Practice Address - Country:US
Practice Address - Phone:808-341-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD288481041C0700X
HI34651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI3465OtherHAWAII LCSW