Provider Demographics
NPI:1922137306
Name:BURKART, EILEEN KOLOGINSKY (PHD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:KOLOGINSKY
Last Name:BURKART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EILEEN
Other - Middle Name:FRANCES
Other - Last Name:BURKART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:444 ANGELL ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4445
Mailing Address - Country:US
Mailing Address - Phone:401-273-5115
Mailing Address - Fax:401-273-8388
Practice Address - Street 1:444 ANGELL ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4445
Practice Address - Country:US
Practice Address - Phone:401-273-5115
Practice Address - Fax:401-273-8388
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI407465OtherBLUE CHIP PROVIDER
RI9324-4OtherPROVIDER, RI BLUE CROSS