Healthcare Provider Details

I. General information

NPI: 1801256854
Provider Name (Legal Business Name): BURKE, NAZAROFF, CUSICK & BUNIN PROFESSIONAL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR SUITE 307L
BEVERLY MA
01915-6115
US

IV. Provider business mailing address

100 CUMMINGS CTR SUITE 307L
BEVERLY MA
01915-6115
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-3301
  • Fax:
Mailing address:
  • Phone: 978-922-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number105607
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105607
License Number StateMA

VIII. Authorized Official

Name: MS. PATRICIA BURKE
Title or Position: PROFESSIONAL COUNSELOR
Credential: MSW
Phone: 978-922-3301