Provider Demographics
NPI:1043965627
Name:BURKE, TAYLOR ADELE (PHD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ADELE
Last Name:BURKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ADELPHI AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4526
Mailing Address - Country:US
Mailing Address - Phone:516-680-9260
Mailing Address - Fax:
Practice Address - Street 1:185 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2790
Practice Address - Country:US
Practice Address - Phone:516-680-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11722103T00000X
RIPS01964103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist