Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 019591-1 | NY |
NPI | 1003200593 |
---|---|
Provider Name | Laraine Catherine Burke |
First Address | Ronkonkoma, NY 11779-4730 |
Second Address | Ronkonkoma, NY 11779-4730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 24/03/2015 |