Provider Demographics
NPI:1891926499
Name:ARDON, MARA GABRIELA
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:GABRIELA
Last Name:ARDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3131
Mailing Address - Country:US
Mailing Address - Phone:781-289-9331
Mailing Address - Fax:
Practice Address - Street 1:265 BEACH ST
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3131
Practice Address - Country:US
Practice Address - Phone:781-289-9331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical