Healthcare Provider Details

I. General information

NPI: 1710527049
Provider Name (Legal Business Name): MARY ELLEN ELLEN PEIRSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 JACKSON ST
ANDERSON IN
46016-4384
US

IV. Provider business mailing address

PO BOX 361327
INDIANAPOLIS IN
46236-1327
US

V. Phone/Fax

Practice location:
  • Phone: 765-646-8444
  • Fax:
Mailing address:
  • Phone: 317-253-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: