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NPI Code Detail

MEDICARE: MOLLY BURKE MSW, LCSW

MEDICARE: MOLLY BURKE MSW, 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
11041C0700XClinical Social Worker149.030269IL

General Provider Information

NPI Number : 1972352649
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY BURKE MSW, LCSW
Provider Business Mailing Address
First Line : 2206 EASTLAND DR STE 101
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-7742
Country : US
Telephone Number : 217-714-7042
Fax Number :
Provider Business Practice Location Address
First Line : 2206 EASTLAND DR STE 101
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-7742
Country : US
Telephone Number : 217-714-7042
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2024
Last Update Date : 03/12/2026

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