Provider Demographics
NPI:1609583251
Name:MARAS, JESSICA ROSS
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ROSS
Last Name:MARAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:CAROL
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:753 S MACON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4433
Mailing Address - Country:US
Mailing Address - Phone:410-430-6966
Mailing Address - Fax:
Practice Address - Street 1:753 S MACON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4433
Practice Address - Country:US
Practice Address - Phone:410-430-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
106S00000XOther106S00000X