Provider Demographics
NPI:1629766001
Name:MORDUCH-TOUBMAN, MAYA
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:MORDUCH-TOUBMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 NW NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1736
Mailing Address - Country:US
Mailing Address - Phone:203-815-7868
Mailing Address - Fax:
Practice Address - Street 1:838 NW NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1736
Practice Address - Country:US
Practice Address - Phone:203-815-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker