Provider Demographics
NPI:1922320464
Name:BURKE, ANN E
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:BURKE
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 1:20 CAMMETT WAY
Mailing Address - Street 2:PO BOX 620
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1505
Mailing Address - Country:US
Mailing Address - Phone:508-873-7537
Mailing Address - Fax:
Practice Address - Street 1:50 LONG POND DR
Practice Address - Street 2:
Practice Address - City:S YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-4180
Practice Address - Country:US
Practice Address - Phone:508-760-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health