Provider Demographics
NPI:1578607537
Name:MARA, JANE ELLEN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELLEN
Last Name:MARA
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 1:697 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3101
Mailing Address - Country:US
Mailing Address - Phone:541-761-7576
Mailing Address - Fax:
Practice Address - Street 1:300 HERSEY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-761-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical