Provider Demographics
NPI:1578549887
Name:BURKE, DAVID M (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BURKE
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 BAY BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5261
Mailing Address - Country:US
Mailing Address - Phone:619-842-2442
Mailing Address - Fax:
Practice Address - Street 1:780 BAY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5261
Practice Address - Country:US
Practice Address - Phone:619-842-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006818103TC1900X
CA35096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling