Healthcare Provider Details

I. General information

NPI: 1083773287
Provider Name (Legal Business Name): MAUREEN ONEAL POLIKOFF MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 MONTGOMERY BLVD NE SUITE 200-W
ALBUQUERQUE NM
87109-6749
US

IV. Provider business mailing address

1519 PHOENIX AVE NW
ALBUQUERQUE NM
87107-1059
US

V. Phone/Fax

Practice location:
  • Phone: 505-321-8506
  • Fax:
Mailing address:
  • Phone: 505-345-1262
  • Fax: 505-345-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-3214
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: