Provider Demographics
NPI:1568950897
Name:EBRIGHT, MAEVE (CD-L, PAIL ADVOCATE)
Entity Type:Individual
Prefix:MRS
First Name:MAEVE
Middle Name:
Last Name:EBRIGHT
Suffix:
Gender:F
Credentials:CD-L, PAIL ADVOCATE
Other - Prefix:
Other - First Name:KODI
Other - Middle Name:
Other - Last Name:EBRIGHT/RENTERIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91 BENT TREE RD APT A
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-9539
Mailing Address - Country:US
Mailing Address - Phone:575-840-7615
Mailing Address - Fax:
Practice Address - Street 1:91 BENT TREE RD APT A
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-9539
Practice Address - Country:US
Practice Address - Phone:575-840-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician