Provider Demographics
NPI:1528151560
Name:BURGER, MARY CANDICE (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CANDICE
Last Name:BURGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 21ST AVE S
Mailing Address - Street 2:SUITE 411
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4942
Mailing Address - Country:US
Mailing Address - Phone:615-812-9299
Mailing Address - Fax:
Practice Address - Street 1:2200 21ST AVE S
Practice Address - Street 2:SUITE 411
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4942
Practice Address - Country:US
Practice Address - Phone:615-812-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP001454103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
EXEMPTMedicare UPIN