Provider Demographics
NPI:1568071587
Name:MARUS, MARY LYNN (MSW, LCSWA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYNN
Last Name:MARUS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BATHGATE LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5553
Mailing Address - Country:US
Mailing Address - Phone:919-240-8869
Mailing Address - Fax:
Practice Address - Street 1:117 BATHGATE LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5553
Practice Address - Country:US
Practice Address - Phone:919-240-8869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0147981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical