Provider Demographics
NPI:1831705698
Name:BURKE, JOSEPH VINCENT
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:VINCENT
Last Name:BURKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 3RD ST APT B8
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-1901
Mailing Address - Country:US
Mailing Address - Phone:434-221-5656
Mailing Address - Fax:
Practice Address - Street 1:612 3RD ST APT B8
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1901
Practice Address - Country:US
Practice Address - Phone:434-221-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional