Provider Demographics
NPI:1871587790
Name:MAFCHIR, POLLY H (LISW)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:H
Last Name:MAFCHIR
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-0194
Mailing Address - Country:US
Mailing Address - Phone:505-982-9336
Mailing Address - Fax:505-983-7897
Practice Address - Street 1:546 HARKLE RD STE C
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4784
Practice Address - Country:US
Practice Address - Phone:505-982-9336
Practice Address - Fax:505-983-7897
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-0914104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker