Provider Demographics
NPI:1902978018
Name:BURT, MARY FRANCES (LCSW, LMFT, CAS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:FRANCES
Last Name:BURT
Suffix:
Gender:F
Credentials:LCSW, LMFT, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 GRAY RD STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3238
Mailing Address - Country:US
Mailing Address - Phone:317-432-3137
Mailing Address - Fax:
Practice Address - Street 1:6801 GRAY RD STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3238
Practice Address - Country:US
Practice Address - Phone:317-432-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002517A1041C0700X
IN35001276A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000309040OtherANTHEM INSURANCE