Provider Demographics
NPI:1932271046
Name:BAYRAKTAR, MARY ARCELIA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ARCELIA
Last Name:BAYRAKTAR
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 1:150 E OLIVE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1849
Mailing Address - Country:US
Mailing Address - Phone:818-846-6782
Mailing Address - Fax:818-846-8813
Practice Address - Street 1:150 E OLIVE AVE
Practice Address - Street 2:STE 101
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1846
Practice Address - Country:US
Practice Address - Phone:818-846-6782
Practice Address - Fax:818-846-8813
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS11509104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker