Mary Katherine Burnett

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6361007296 Issued in MI

Practice address

862 Nottingham Rd Apt 2S
Grosse Pointe Park, MI 48230-1755

Phone

(313) 613-9165

NPI assigned

Aug 5, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1417567314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "862 NOTTINGHAM RD APT 2S",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "862 NOTTINGHAM RD APT 2S",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301755",
            "telephone_number": "313-613-9165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNETT",
        "first_name": "MARY KATHERINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-05",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6361007296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Detroit",
            "affiliation": "N",
            "address_1": "862 Nottingham Rd Apt 2S",
            "city": "Grosse Pointe Park",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482301755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Psychologist in Grosse Pointe Park, MI
• Providers in Grosse Pointe Park, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.