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General NPI Number Information
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NPI Number | 1346838166
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Entity Type | Individual
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Provider Name | KELSEY JUNE BURKE
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Gender | Female
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 157 BEACH 116TH ST
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2430
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Country | US
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Telephone | 631-786-5236
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Fax |
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Provider Business Mailing Address
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Address Line | 207 SUYDAM LN
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City | BAYPORT
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State | NY
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Zip | 11705-2152
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Country | US
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Telephone | 631-786-5236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | NY
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