Provider Demographics
NPI:1902943103
Name:BURKE, CHERYL ANN (PSYD , LMHC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:BURKE
Suffix:
Gender:F
Credentials:PSYD , LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-1866
Mailing Address - Country:US
Mailing Address - Phone:407-704-3166
Mailing Address - Fax:866-754-2339
Practice Address - Street 1:2431 ALOMA AVE SUITE 251
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2900
Practice Address - Country:US
Practice Address - Phone:407-704-3166
Practice Address - Fax:866-754-2339
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL311671OtherWELLCARE PROVIDER ID
FLZ036GOtherBLUE CROSS BLUE SHIELD PR
FL266648OtherAMERIGROUP PROVIDER ID