Provider Demographics
NPI:1841761681
Name:MARRA, GINA M (MA,LPC)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:M
Last Name:MARRA
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:WACHTEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GINA M MARRA, MA,LPC
Mailing Address - Street 1:127 GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-3603
Mailing Address - Country:US
Mailing Address - Phone:973-975-5332
Mailing Address - Fax:
Practice Address - Street 1:127 GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-3603
Practice Address - Country:US
Practice Address - Phone:973-975-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00623900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty