Provider Demographics
NPI:1740492164
Name:BURKE, DAVID ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:BURKE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N BEDFORD DR STE 309
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4307
Mailing Address - Country:US
Mailing Address - Phone:310-358-7515
Mailing Address - Fax:
Practice Address - Street 1:450 N BEDFORD DR STE 309
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4307
Practice Address - Country:US
Practice Address - Phone:310-358-7515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical