MEDICARE: PATRICK J 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	256763	KY

General Provider Information

NPI Number	:	1356965024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK J BURKE LCSW

Provider Business Mailing Address
First Line	:	10401 LINN STATION RD STE 100
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3842
Country	:	US
Telephone Number	:	502-589-8600
Fax Number	:	502-921-0222

Provider Business Practice Location Address
First Line	:	130 JOE B HALL AVE
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-6010
Country	:	US
Telephone Number	:	502-955-5447
Fax Number	:

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

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	12/09/2022

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