Provider Demographics
NPI:1134337488
Name:BURKE, MARIE E (MSSA,ACSW,LISW,LPCC)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:E
Last Name:BURKE
Suffix:
Gender:F
Credentials:MSSA,ACSW,LISW,LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11485 OAK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9631
Mailing Address - Country:US
Mailing Address - Phone:440-286-1600
Mailing Address - Fax:
Practice Address - Street 1:113 N HAMBDEN ST
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1166
Practice Address - Country:US
Practice Address - Phone:440-285-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001333101Y00000X, 101YM0800X, 101YP2500X
OHI0003134104100000X, 1041C0700X, 1041S0200X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist