Provider Demographics
NPI:1134568496
Name:MARALLO GREEN, ASHLEY (LICSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MARALLO GREEN
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 NISQUALLY CUT OFF RD SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-9649
Mailing Address - Country:US
Mailing Address - Phone:406-241-1919
Mailing Address - Fax:
Practice Address - Street 1:416 NISQUALLY CUT OFF RD SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-9649
Practice Address - Country:US
Practice Address - Phone:406-241-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608697351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical