MEDICARE: MRS. SUSAN A. BURKE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW013432	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346241379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN A. BURKE LCSW

Provider Business Mailing Address
First Line	:	1333 W MAIN ST
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1056
Country	:	US
Telephone Number	:	724-372-2062
Fax Number	:	724-297-3131

Provider Business Practice Location Address
First Line	:	1333 W MAIN ST
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1056
Country	:	US
Telephone Number	:	724-372-2062
Fax Number	:	724-297-3131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	10/31/2018

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