Provider Demographics
NPI:1427402130
Name:HART, CLAIRA NICHOLE (RBT)
Entity Type:Individual
Prefix:
First Name:CLAIRA
Middle Name:NICHOLE
Last Name:HART
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:CLAIRA
Other - Middle Name:NICHOLE
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 PERKINS DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3248
Mailing Address - Country:US
Mailing Address - Phone:575-652-3155
Mailing Address - Fax:575-652-4104
Practice Address - Street 1:715 E IDAHO AVE STE 2B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-4701
Practice Address - Country:US
Practice Address - Phone:575-556-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRBT-16-23426OtherBEHAVIOR ANALYST CERTIFICATION BOARD CERTIFICATE NUMBER
NM39177238Medicaid