Provider Demographics
NPI:1184166423
Name:BURNS, MARCIE ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:ANN
Last Name:BURNS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 WILSHIRE AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2569
Mailing Address - Country:US
Mailing Address - Phone:505-399-9135
Mailing Address - Fax:
Practice Address - Street 1:5501 WILSHIRE AVE NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2569
Practice Address - Country:US
Practice Address - Phone:505-399-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM096121041C0700X
NMC-108141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical