Provider Demographics
NPI:1588288716
Name:HYATT, MARA (LICSW)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:HYATT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 MAIN ST
Mailing Address - Street 2:#373
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451
Mailing Address - Country:US
Mailing Address - Phone:617-744-9297
Mailing Address - Fax:
Practice Address - Street 1:738 MAIN ST
Practice Address - Street 2:#373
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451
Practice Address - Country:US
Practice Address - Phone:617-744-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1222411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical