Provider Demographics
NPI:1396208690
Name:MARLA P. MEYER, LICSW LLC
Entity Type:Organization
Organization Name:MARLA P. MEYER, LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:781-576-0860
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-0249
Mailing Address - Country:US
Mailing Address - Phone:781-576-0860
Mailing Address - Fax:
Practice Address - Street 1:237 WASHINGTON ST FL 2
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-3334
Practice Address - Country:US
Practice Address - Phone:781-576-0860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1669950267Medicaid
MA110158712AMedicaid
MA14371402OtherCAQH