Provider Demographics
NPI:1770058364
Name:BURNS, MARY ELLEN (CASAC-T)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:BURNS
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 ROUTE 376
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6483
Mailing Address - Country:US
Mailing Address - Phone:845-765-2366
Mailing Address - Fax:845-765-2367
Practice Address - Street 1:942 ROUTE 376
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6483
Practice Address - Country:US
Practice Address - Phone:845-765-2366
Practice Address - Fax:845-765-2367
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)