Provider Demographics
NPI:1073919734
Name:GOLDBERG, MARA ELIZABETH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:ELIZABETH
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:ELIZABETH
Other - Last Name:WARD-GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 CUMMINGS CENTER
Mailing Address - Street 2:SUITE 416U
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:617-545-7568
Mailing Address - Fax:
Practice Address - Street 1:900 CUMMINGS CENTER
Practice Address - Street 2:SUITE 416U
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:617-545-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1183881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical