MEDICARE: AMY BURKE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	12194	FL

General Provider Information

NPI Number	:	1285098954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BURKE LCSW

Provider Business Mailing Address
First Line	:	10920 MCKINLEY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6471
Country	:	US
Telephone Number	:	813-745-5496
Fax Number	:	813-745-7253

Provider Business Practice Location Address
First Line	:	10920 MCKINLEY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6471
Country	:	US
Telephone Number	:	813-745-5496
Fax Number	:	813-745-7253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2016
Last Update Date	:	04/08/2016

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