Provider Demographics
NPI:1780310284
Name:OLIPHANT, MARIA LYNN (MSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LYNN
Last Name:OLIPHANT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5529 HILL N DALE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4813
Mailing Address - Country:US
Mailing Address - Phone:360-431-5261
Mailing Address - Fax:
Practice Address - Street 1:520 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-5359
Practice Address - Country:US
Practice Address - Phone:360-431-5261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool