Provider Demographics
NPI:1659304137
Name:ALBURTUS, MARY JO (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:ALBURTUS
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 1:2 CONSTABLE ST
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1918
Mailing Address - Country:US
Mailing Address - Phone:732-219-9388
Mailing Address - Fax:
Practice Address - Street 1:2 CONSTABLE ST
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1918
Practice Address - Country:US
Practice Address - Phone:732-219-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004009001041C0700X
NJ44SC004009000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7401261002OtherGHI
NJ5772290OtherAETNA
AL717867Medicare ID - Type Unspecified
NJ0554679000OtherAMERIHEALTH
NJ7401261002OtherGHI