Doctor Name: | MR. GLENARD EDWARD BURKE |
NPI Number: | 1548576176 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCADCNCACII, CCVS,BA |
License Number: | 37LC00128500 |
Business Practice Address: | 185 Route 183 Stanhope, NJ - 07874 |
Business Phone Number: | 9734261640 |
Business Fax Number: | 9734261641 |
Mailing Address: | 185 Route 183, STANHOPE |
State: | NJ |
Postal Code: | 07874 |
Phone Number: | 9734261640 |
Fax Number: | 9734261641 |
NPI Enumeration Date: | 08/20/2010 |
NPI Last Update Date: | 08/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 37LC00128500 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |