MEDICARE: CHRISTINA BURKE LMHC

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	101YM0800X	Mental Health Counselor	MHC01446	RI

General Provider Information

NPI Number	:	1356024558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA BURKE LMHC

Provider Business Mailing Address
First Line	:	1130 TEN ROD RD STE E205
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4168
Country	:	US
Telephone Number	:	401-645-4107
Fax Number	:	401-340-1542

Provider Business Practice Location Address
First Line	:	1130 TEN ROD RD STE E205
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4168
Country	:	US
Telephone Number	:	401-645-4107
Fax Number	:	401-340-1542

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

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	11/04/2024

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