Provider Demographics
NPI:1801439187
Name:OAKMAN-MAHAFFEY, AJA (LCSW)
Entity type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:OAKMAN-MAHAFFEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2267 LAVA RIDGE CT STE 125
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2267 LAVA RIDGE CT STE 125
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4275
Practice Address - Country:US
Practice Address - Phone:925-895-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA675731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical