Provider Information for 1104807338
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Ms. CELESTE S BURCHAM MSW
Sex: Female
NPI: 1104807338
Last Updated: 2016-09-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1104807338 | ||||||||
| Enumeration Date | 2005-11-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6626 E 75TH ST STE 500 INDIANAPOLIS, IN 46250-2805 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 1525 N RITTER AVE INDIANAPOLIS, IN 46219-3026 United States Phone: 317-359-5467 | Fax: | ||||||||
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