Provider Demographics
NPI:1174175780
Name:BURKE, CYNTHIA L
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:BURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 1135
Mailing Address - Street 2:
Mailing Address - City:ONSET
Mailing Address - State:MA
Mailing Address - Zip Code:02558-1135
Mailing Address - Country:US
Mailing Address - Phone:203-788-9255
Mailing Address - Fax:
Practice Address - Street 1:403 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5324
Practice Address - Country:US
Practice Address - Phone:508-427-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health