Healthcare Provider Details

I. General information

NPI: 1215073002
Provider Name (Legal Business Name): JENNIFER CATHY BURKE LMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE ST STE B1
HOLYOKE MA
01040-5143
US

IV. Provider business mailing address

47 HARWICH RD
WEST SPRINGFIELD MA
01089-3019
US

V. Phone/Fax

Practice location:
  • Phone: 413-532-9446
  • Fax:
Mailing address:
  • Phone: 413-209-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001412
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: