Provider Demographics
NPI:1922463447
Name:WILLIAMS-BURKE, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:WILLIAMS-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 1:550 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2672
Mailing Address - Country:US
Mailing Address - Phone:631-369-1277
Mailing Address - Fax:631-208-3445
Practice Address - Street 1:550 EAST MAIN ST SUITE 103
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-369-1277
Practice Address - Fax:631-208-3445
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OOOOOOOOOO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health