MEDICARE: MARRA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871185173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARRA PLLC

Provider Business Mailing Address
First Line	:	200 W GRANDVIEW ST
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-4366
Country	:	US
Telephone Number	:	312-405-2784
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N GREEN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-5996
Country	:	US
Telephone Number	:	312-405-2784
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CLARA E BRENNECKE
Credential	:	LCPC
Telephone Number	:	312-405-2784

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	03/17/2026

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