Healthcare Provider Details

I. General information

NPI: 1255241626
Provider Name (Legal Business Name): ADAM BURKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 COLLEGE AVE STE 206
WATERVILLE ME
04901-6100
US

IV. Provider business mailing address

32 COLLEGE AVE STE 206
WATERVILLE ME
04901-6100
US

V. Phone/Fax

Practice location:
  • Phone: 207-680-2065
  • Fax: 207-680-2068
Mailing address:
  • Phone: 207-680-2065
  • Fax: 207-680-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL9024
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: