Provider Demographics
NPI:1932316197
Name:PIES, MARY JEANNE (MTS, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEANNE
Last Name:PIES
Suffix:
Gender:F
Credentials:MTS, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 N 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1001
Mailing Address - Country:US
Mailing Address - Phone:317-787-8267
Mailing Address - Fax:
Practice Address - Street 1:610 E SOUTHPORT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8590
Practice Address - Country:US
Practice Address - Phone:317-782-3838
Practice Address - Fax:317-782-6929
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002860A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical