Healthcare Provider Details

I. General information

NPI: 1972527745
Provider Name (Legal Business Name): ELIZABETH MORRILL BURKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 OLD SAWMILL LN
ARUNDEL ME
04046-8164
US

IV. Provider business mailing address

5 OAKDALE ST
PORTLAND ME
04103-4821
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-8998
  • Fax: 207-985-1281
Mailing address:
  • Phone: 207-772-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC10454
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: