Provider Demographics
NPI:1780870493
Name:BURNS, RENAE M (MSW LCSW)
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:M
Last Name:BURNS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MULBERRY STREET
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1230
Mailing Address - Country:US
Mailing Address - Phone:812-423-7791
Mailing Address - Fax:812-422-7558
Practice Address - Street 1:415 MULBERRY STREET
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1230
Practice Address - Country:US
Practice Address - Phone:812-423-7791
Practice Address - Fax:812-422-7558
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005369A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000532878OtherANTHEM
IN11780074OtherCAQH
IN100240880Medicaid
IN839090GGGGMedicare PIN