Provider Demographics
NPI:1740750637
Name:FAY, AMARIS B (MSW)
Entity Type:Individual
Prefix:
First Name:AMARIS
Middle Name:B
Last Name:FAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:AMARIS
Other - Middle Name:B
Other - Last Name:EHLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:NM
Mailing Address - Zip Code:88026-0234
Mailing Address - Country:US
Mailing Address - Phone:575-654-5995
Mailing Address - Fax:
Practice Address - Street 1:214 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5353
Practice Address - Country:US
Practice Address - Phone:575-654-2919
Practice Address - Fax:575-342-5081
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-10897104100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker