Provider Demographics
NPI:1770877474
Name:BURKETT, WILLIAM VERNARD (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:VERNARD
Last Name:BURKETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-5109
Mailing Address - Country:US
Mailing Address - Phone:727-374-6188
Mailing Address - Fax:
Practice Address - Street 1:3747 34TH ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-3836
Practice Address - Country:US
Practice Address - Phone:727-867-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW31861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical