Provider Demographics
NPI:1396982369
Name:BURKE, STEPHEN JASON (MSW LICSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JASON
Last Name:BURKE
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-0466
Mailing Address - Country:US
Mailing Address - Phone:603-502-4994
Mailing Address - Fax:
Practice Address - Street 1:50 NASHUA RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3400
Practice Address - Country:US
Practice Address - Phone:603-502-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1116041041C0700X
NH14431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical