Provider Demographics
NPI:1588601066
Name:RAYE, MARINA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:RAYE
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 1:59 MINOT AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1655
Mailing Address - Country:US
Mailing Address - Phone:508-496-6126
Mailing Address - Fax:877-308-2202
Practice Address - Street 1:92 FAUNCE CORNER RD UNIT 110
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1262
Practice Address - Country:US
Practice Address - Phone:508-496-6126
Practice Address - Fax:877-308-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113098101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP2373301Medicare PIN
RIP2373302Medicare PIN
MAP23733Medicare ID - Type Unspecified