Provider Demographics
NPI:1124848429
Name:NOLASCO, MARA (LCSW)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:NOLASCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 SAVANNAH HWY APT 1030
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-6784
Mailing Address - Country:US
Mailing Address - Phone:401-408-0744
Mailing Address - Fax:
Practice Address - Street 1:337 SAVANNAH HWY APT 1030
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-6784
Practice Address - Country:US
Practice Address - Phone:401-408-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC173541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical