Provider Demographics
NPI:1942296553
Name:BURKOWSKY, ELLEN SUE (MSW LCSW LCADC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:SUE
Last Name:BURKOWSKY
Suffix:
Gender:F
Credentials:MSW LCSW LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6007
Mailing Address - Country:US
Mailing Address - Phone:732-842-6744
Mailing Address - Fax:732-842-5903
Practice Address - Street 1:211 COOPER RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-6007
Practice Address - Country:US
Practice Address - Phone:732-842-6744
Practice Address - Fax:732-842-5903
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJLCADC37LC00074800101YA0400X
NJLCSW44SC00034700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
637206Medicare ID - Type Unspecified