Provider Demographics
NPI:1033480157
Name:BURKE, BETHANY D (LCSW)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:D
Last Name:BURKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:DIANE
Other - Last Name:KIEFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 CLARA BARTON ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9503
Mailing Address - Country:US
Mailing Address - Phone:585-335-6001
Mailing Address - Fax:585-335-9728
Practice Address - Street 1:9221 ROBERT HART DR
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-8931
Practice Address - Country:US
Practice Address - Phone:585-335-4316
Practice Address - Fax:585-335-3577
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0781411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical