Healthcare Provider Details

I. General information

NPI: 1437344173
Provider Name (Legal Business Name): LEO JOSEPH BURKE III PSY.D., P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 MAPLE ST # B-3
NEW ORLEANS LA
70118-5068
US

IV. Provider business mailing address

7611 MAPLE ST # B-3
NEW ORLEANS LA
70118-5068
US

V. Phone/Fax

Practice location:
  • Phone: 504-232-7338
  • Fax: 504-323-1992
Mailing address:
  • Phone: 504-232-7338
  • Fax: 504-323-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC004513
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004513
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1375
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS017349
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS017349
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number304056
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: