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NPI Code Detail

MEDICARE: ANNA RUTH BURSE LSW, LCSW

MEDICARE: ANNA RUTH BURSE LSW, LCSW
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 Worker33009925AIN

General Provider Information

NPI Number : 1780467241
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA RUTH BURSE LSW, LCSW
Provider Business Mailing Address
First Line : 2868 N PENNSYLVANIA ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-4125
Country : US
Telephone Number : 317-221-3400
Fax Number :
Provider Business Practice Location Address
First Line : 2868 N PENNSYLVANIA ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-4125
Country : US
Telephone Number : 317-221-3400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2023
Last Update Date : 09/13/2023

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