Provider Information for 1902041759
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Ms. KELLY L BURKETT MS, CRC, LMHC
Sex: Female
NPI: 1902041759
Last Updated: 2011-10-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1902041759 | ||||||||||||
| Enumeration Date | 2008-12-09 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4939 ERNEST WAY CLAY, NY 13041 United States Phone: 585-739-2492 | Fax: | ||||||||||||
| Primary Practice Address | 813 FAY RD SYRACUSE, NY 13219-3009 United States Phone: 315-488-3804 | Fax: | ||||||||||||
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