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NPI Code Detail

MEDICARE: MS. CELESTE S BURCHAM MSW

MEDICARE: MS. CELESTE S BURCHAM MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34001908AIN

General Provider Information

NPI Number : 1104807338
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CELESTE S BURCHAM MSW
Provider Business Mailing Address
First Line : 6626 E 75TH ST
Second Line : STE 500
City : INDIANAPOLIS
State : IN
Zip : 46250-2805
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1525 N RITTER AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-3026
Country : US
Telephone Number : 317-359-5467
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2005
Last Update Date : 09/21/2016

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