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General NPI Number Information
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NPI Number | 1346965894
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Entity Type | Individual
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Provider Name | SANDRA MARRA LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 667 JESSANDA CIR
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City | LAKELAND
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State | FL
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Zip | 33813-2682
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Country | US
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Telephone | 786-553-0951
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Fax |
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Provider Business Mailing Address
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Address Line | 667 JESSANDA CIR
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City | LAKELAND
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State | FL
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Zip | 33813-2682
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Country | US
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Telephone | 786-553-0951
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 735620
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW16807
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License Number State | FL
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