Mary Jo Burns, PHD, APRN, BC-PMH
Individual provider Active NPI Psychologist · Rome, NY
NPI 1326101643 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1326101643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- RN158632NY (NY)
- Practice address
- 110 E Chestnut St
Rome, NY 13440-2832 - Phone
- (315) 339-3597
- Fax
- (315) 339-1844
- NPI assigned
- Dec 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Specialist, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN158632NY | NY | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | RN158632NY | NY | Yes |
Addresses
Primary practice location
110 E Chestnut St
Rome, NY 13440-2832
Mailing address
110 E Chestnut St
Rome, NY 13440-2832
Phone (315) 339-3597
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3191621 | Other | NY | GHI |
| 121197 | Other | NY | VALUE OPTIONS |
Other providers in Rome, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.