Individual
ELLINOR R BURKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1201 SHADOWLAWN DR STE 101, SAINT MARYS, GA 31558-4074
(912) 744-0993
(912) 744-0993
Mailing address
PO BOX 5099, SAINT MARYS, GA 31558-5099
(912) 882-3662
(912) 882-7720
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
35SI00313400
NJ
103T00000X
Psychologist
Primary
PSY003747
GA
103T00000X
Psychologist
PSY003747
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6248306
—
NJ
Enumeration date
06/30/2005
Last updated
07/01/2020
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