Provider Demographics
NPI:1942915855
Name:BURBANK, EMILY (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BURBANK
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WASHBURN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDON
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 WASHBURN AVE
Practice Address - Street 2:
Practice Address - City:LYNDON
Practice Address - State:KY
Practice Address - Zip Code:40222-4725
Practice Address - Country:US
Practice Address - Phone:502-625-5265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY269647101YA0400X
KY2562371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)