Provider Demographics
NPI:1497837843
Name:SALIS, MARA (LICSW)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:SALIS
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 1:8 CARLSON CIR
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4205
Mailing Address - Country:US
Mailing Address - Phone:781-439-1123
Mailing Address - Fax:
Practice Address - Street 1:2 EGLIN ST
Practice Address - Street 2:
Practice Address - City:HANSCOM AFB
Practice Address - State:MA
Practice Address - Zip Code:01731
Practice Address - Country:US
Practice Address - Phone:781-274-6178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1118281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical