Healthcare Provider Details

I. General information

NPI: 1982181665
Provider Name (Legal Business Name): CATHERINE BURKE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 ELM ST
BENNINGTON VT
05201-2249
US

IV. Provider business mailing address

PO BOX 4621
BENNINGTON VT
05201-4621
US

V. Phone/Fax

Practice location:
  • Phone: 802-375-7487
  • Fax:
Mailing address:
  • Phone: 802-375-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0134144
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: