Individual
MARA SAN NICOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
400 ROUTE 8 STE 303, MAITE, GU 96910-2003
(671) 475-0061
Mailing address
PO BOX 907, HAGATNA, GU 96932-0907
(671) 777-0098
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW-2466
HI
Other
Enumeration date
03/29/2018
Last updated
03/29/2018
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