Healthcare Provider Details

I. General information

NPI: 1528277951
Provider Name (Legal Business Name): FREYA L BURKET A.C.S.W., L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W JEFFERSON BLVD
SOUTH BEND IN
46601-1994
US

IV. Provider business mailing address

111 W JEFFERSON BLVD
SOUTH BEND IN
46601-1994
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-2624
  • Fax: 574-239-6460
Mailing address:
  • Phone: 574-647-2624
  • Fax: 574-239-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001653A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: