Healthcare Provider Details

I. General information

NPI: 1740750637
Provider Name (Legal Business Name): AMARIS B FAY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMARIS B EHLINGER

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W BROADWAY ST
SILVER CITY NM
88061-5353
US

IV. Provider business mailing address

PO BOX 234
SANTA CLARA NM
88026-0234
US

V. Phone/Fax

Practice location:
  • Phone: 575-654-2919
  • Fax: 575-342-5081
Mailing address:
  • Phone: 575-654-5995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberX-10897
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: