Healthcare Provider Details

I. General information

NPI: 1144145582
Provider Name (Legal Business Name): WALTER BURKE LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 TARWORTH TER
MANCHESTER NJ
08759-6671
US

IV. Provider business mailing address

9 TARWORTH TER
MANCHESTER NJ
08759-6671
US

V. Phone/Fax

Practice location:
  • Phone: 732-234-0058
  • Fax:
Mailing address:
  • Phone: 732-234-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00380200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: