Healthcare Provider Details

I. General information

NPI: 1376348250
Provider Name (Legal Business Name): MARA LAW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 N DETROIT ST
XENIA OH
45385-2909
US

IV. Provider business mailing address

36 N DETROIT ST
XENIA OH
45385-2909
US

V. Phone/Fax

Practice location:
  • Phone: 937-610-4673
  • Fax:
Mailing address:
  • Phone: 937-610-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS.1904313
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1904313
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: