Provider Demographics
NPI:1568054112
Name:FREY, MARA D (LMHC)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:D
Last Name:FREY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11354 SEA GRASS CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4919
Mailing Address - Country:US
Mailing Address - Phone:516-790-7314
Mailing Address - Fax:
Practice Address - Street 1:7700 RENFREW LN
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3508
Practice Address - Country:US
Practice Address - Phone:954-698-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health