Provider Demographics
NPI:1386233658
Name:MARA THERAPY LLC
Entity type:Organization
Organization Name:MARA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOODMAN-DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-344-5221
Mailing Address - Street 1:PO BOX 2220
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-5220
Mailing Address - Country:US
Mailing Address - Phone:413-344-5221
Mailing Address - Fax:
Practice Address - Street 1:17 BISHOP EST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2803
Practice Address - Country:US
Practice Address - Phone:413-344-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty