Provider Demographics
NPI:1770354037
Name:BURKE, CANDICE RAE (PSYD)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:RAE
Last Name:BURKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MOORFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5230
Mailing Address - Country:US
Mailing Address - Phone:856-906-7681
Mailing Address - Fax:
Practice Address - Street 1:1930 MARLTON PIKE E STE J50
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-4106
Practice Address - Country:US
Practice Address - Phone:856-398-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00735100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist