Provider Demographics
NPI:1710706627
Name:BURKE, PATRICK (M ED, BCBA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BURKE
Suffix:
Gender:M
Credentials:M ED, BCBA
Other - Prefix:
Other - First Name:PADDY
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M ED, BCBA
Mailing Address - Street 1:9 LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1230
Mailing Address - Country:US
Mailing Address - Phone:860-608-8538
Mailing Address - Fax:860-608-8538
Practice Address - Street 1:9 LAKEVIEW ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1230
Practice Address - Country:US
Practice Address - Phone:860-608-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003757103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty