Provider Demographics
NPI:1972739423
Name:BURKE, ERYN ELIZABETH (BA)
Entity Type:Individual
Prefix:
First Name:ERYN
Middle Name:ELIZABETH
Last Name:BURKE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DUNSTABLE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-2940
Mailing Address - Country:US
Mailing Address - Phone:617-997-3911
Mailing Address - Fax:
Practice Address - Street 1:19 DUNSTABLE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-2940
Practice Address - Country:US
Practice Address - Phone:617-997-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator