Healthcare Provider Details

I. General information

NPI: 1194843409
Provider Name (Legal Business Name): MARK STEPHEN BURKES MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NATIONAL DR
GLASTONBURY CT
06033-4371
US

IV. Provider business mailing address

110 NATIONAL DR
GLASTONBURY CT
06033-4371
US

V. Phone/Fax

Practice location:
  • Phone: 860-657-8910
  • Fax: 860-657-8912
Mailing address:
  • Phone: 860-657-8910
  • Fax: 860-657-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC42315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: