Healthcare Provider Details

I. General information

NPI: 1033819792
Provider Name (Legal Business Name): CHERI OLIVAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 EMERALD DR NW
ALBUQUERQUE NM
87120-3291
US

IV. Provider business mailing address

8015 EMERALD DR NW
ALBUQUERQUE NM
87120-3291
US

V. Phone/Fax

Practice location:
  • Phone: 505-379-4740
  • Fax:
Mailing address:
  • Phone: 505-379-4740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-06236
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: