Provider Demographics
NPI:1568685048
Name:LANGE, CLAUDIA MONICA (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:CLAUDIA
Middle Name:MONICA
Last Name:LANGE
Suffix:
Gender:F
Credentials:LMSW
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 820
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-0820
Mailing Address - Country:US
Mailing Address - Phone:575-643-5258
Mailing Address - Fax:
Practice Address - Street 1:110 COOK AVE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740
Practice Address - Country:US
Practice Address - Phone:575-643-5258
Practice Address - Fax:575-445-2658
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM05464104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03634078Medicaid