Provider Demographics
NPI:1710784202
Name:BURKE, ALFONSO
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:BURKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 BUFFLEHEAD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1979
Mailing Address - Country:US
Mailing Address - Phone:614-207-2626
Mailing Address - Fax:
Practice Address - Street 1:680 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2100
Practice Address - Country:US
Practice Address - Phone:614-669-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor