Healthcare Provider Details

I. General information

NPI: 1134552169
Provider Name (Legal Business Name): WENDY ROSE BURKE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 WILSHIRE BLVD SUITE 708
BEVERLY HILLS CA
90212-2021
US

IV. Provider business mailing address

9720 WILSHIRE BLVD SUITE 708
BEVERLY HILLS CA
90212-2021
US

V. Phone/Fax

Practice location:
  • Phone: 310-364-1950
  • Fax: 310-276-5876
Mailing address:
  • Phone: 310-364-1950
  • Fax: 310-276-5876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 13152
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY0005340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: