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Shanika La'Tia Burke

Social Worker

Behavioral Health & Social Service Providers

10711 Red Run Blvd Ste 112, Owings Mills, MD 21117-5138

PECOS Enrollment

This provider is enrolled in PECOS as SHANIKA BURKE.

Based on the most recent information from CMS, provider Shanika La'Tia Burke is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 10:04 AM.

Profile Details

Provider ID
1114260262
Provider Type
Individual
Full Name
Burke, Shanika La'Tia
Credential
LCSW-C

Gender
Female
Sole Proprietor
Yes
Enumeration Date
3/27/2013
Last Updated
4/11/2024

Contact Information

Practice Location

10711 Red Run Blvd Ste 112, Owings Mills, MD 21117-5138

(443) 977-8879

Unlisted Fax

Mailing Location

825 Amherst Ln, Westminster, MD 21158-4350

(443) 977-8879

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 16318 Maryland

Provider Identifiers

ID	Description	Issuer
ID 443232100	Description Medicaid	Issuer Unlisted Maryland

Shanika La'Tia Burke

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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