Individual provider Active NPI

Mary E Burcham, LISW-CP

  • Clinical Social Worker
  • Summerville, SC
National Provider Identifier
1720846967
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
8523 Issued in SC
Practice address
314 W 4TH North Ft.Street
Summerville, SC 29483
Phone
(843) 501-1099
NPI assigned
Mar 12, 2024
Last updated
Mar 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 8523 SC Primary

Addresses

Primary practice location

314 W 4TH North Ft.Street
Summerville, SC 29483

Mailing address

9366 Ayscough Rd
Summerville, SC 29485-8677
Phone (843) 437-9711

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240424003571 SC Practitioner - Clinical Social Worker 1658711601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Counseling Center PCGroup PAC ID 6204125107, 186 clinicians

Practice addresses (Care Compare)

314 W 4TH N St
Summerville, SC 29483-6550
Phone (843) 501-1099

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Counseling Center PC Clinical CurrentSince Apr 12, 2024 Accepting new patients
Myrtle Beach Counseling Center PastSince Aug 6, 2019 Accepting new patients

Locations

871 Lowcountry Blvd
Ste 200
Mt Pleasant, SC 29464
Phone (253) 346-0137

4000 Faber Place Dr
Ste 110
North Charleston, SC 29405
Phone (854) 246-1100

314 W 4th North St
Summerville, SC 29483
Phone (631) 942-8629

651 Scholar Way
Ste 101
Summerville, SC 29486
Phone (630) 884-9012

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1720846967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9366 AYSCOUGH RD",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294858677",
            "telephone_number": "843-437-9711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 W 4TH NORTH FT.STREET",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "29483",
            "telephone_number": "843-501-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURCHAM",
        "first_name": "MARY",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "LISW-CP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "8523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

Verify at the official NPI Registry.