MEDICARE: MARY P BURKE LPC-IT

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	8892-226	WI

General Provider Information

NPI Number	:	1417807074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY P BURKE LPC-IT

Provider Business Mailing Address
First Line	:	2644 N 97TH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-1650
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2644 N 97TH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-1650
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ MARY P BURKE LPC-IT” Practice Location

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