Provider Demographics
NPI:1851978704
Name:MAFFEI, ELMIRA
Entity Type:Individual
Prefix:
First Name:ELMIRA
Middle Name:
Last Name:MAFFEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELMIRA
Other - Middle Name:
Other - Last Name:ADENYAYEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9201 WARREN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6242
Mailing Address - Country:US
Mailing Address - Phone:214-645-0624
Mailing Address - Fax:
Practice Address - Street 1:1430 EMPIRE CENTRAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4032
Practice Address - Country:US
Practice Address - Phone:214-645-8500
Practice Address - Fax:214-648-3775
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX1040701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104070OtherLICENSE