Provider Demographics
NPI:1346965894
Name:MARRA, SANDRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:MARRA
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 1:667 JESSANDA CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2682
Mailing Address - Country:US
Mailing Address - Phone:786-553-0951
Mailing Address - Fax:
Practice Address - Street 1:667 JESSANDA CIR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2682
Practice Address - Country:US
Practice Address - Phone:786-553-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7356201041S0200X
1041S0200X
FLSW168071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool