Individual
KYRA DIFFEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2600 N FAIRVIEW AVE, FARMINGTON, NM 87401-4502
(505) 793-3283
Mailing address
PO BOX 424, FARMINGTON, NM 87499-0424
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M-11469
NM
1041C0700X
Clinical Social Worker
Primary
SWB-2023-0053
NM
106S00000X
Behavior Technician
—
—
Other
Enumeration date
07/17/2020
Last updated
03/19/2024
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