Provider Demographics
NPI:1639399454
Name:DUPRE-BURNS, MARY ELLEN (LPC)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:DUPRE-BURNS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 COLBURN CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8211
Mailing Address - Country:US
Mailing Address - Phone:973-696-0800
Mailing Address - Fax:973-696-1450
Practice Address - Street 1:11 COLBURN CT
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8211
Practice Address - Country:US
Practice Address - Phone:973-696-0800
Practice Address - Fax:973-696-1450
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00186700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health