Healthcare Provider Details

I. General information

NPI: 1891114286
Provider Name (Legal Business Name): MARI LYFORD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 EUBANK BLVD NE STE 2
ALBUQUERQUE NM
87112-5300
US

IV. Provider business mailing address

5801 EUBANK BLVD NE APT 109
ALBUQUERQUE NM
87111-6186
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-2043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: