Healthcare Provider Details

I. General information

NPI: 1780251264
Provider Name (Legal Business Name): MARA YACOBI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 N FRANKLIN TPKE
RAMSEY NJ
07446-2035
US

IV. Provider business mailing address

15 YEOMANS LN
ALLENDALE NJ
07401-2023
US

V. Phone/Fax

Practice location:
  • Phone: 973-477-5480
  • Fax:
Mailing address:
  • Phone: 201-838-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05497500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: