MEDICARE: SAMANTHA OLIVAS MA, M.ED., BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1891175923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA OLIVAS MA, M.ED., BCBA

Provider Business Mailing Address
First Line	:	6300 RIVERSIDE PLAZA LN NW STE 118
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-2617
Country	:	US
Telephone Number	:	505-366-9512
Fax Number	:

Provider Business Practice Location Address
First Line	:	7704 SAN FRANCISQUITA CT NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-3653
Country	:	US
Telephone Number	:	505-366-9512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	12/17/2025

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