Provider Demographics
NPI:1467491902
Name:BARA, MARILYN JOAN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:JOAN
Last Name:BARA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 MIDTOWN PL # 104-120
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-1300
Mailing Address - Country:US
Mailing Address - Phone:919-971-2282
Mailing Address - Fax:919-821-1434
Practice Address - Street 1:1631 MIDTOWN PL # 104-120
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-1300
Practice Address - Country:US
Practice Address - Phone:919-971-2282
Practice Address - Fax:919-821-1434
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0012801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2877903Medicare ID - Type UnspecifiedMEDICARE NUMBER
NC130412Medicare UPIN
NC60280Medicare UPIN