Provider Demographics
NPI:1851614861
Name:VISCARRA, PAIGE G (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:G
Last Name:VISCARRA
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 10TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5046
Mailing Address - Country:US
Mailing Address - Phone:575-437-2453
Mailing Address - Fax:575-443-1504
Practice Address - Street 1:1601 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5046
Practice Address - Country:US
Practice Address - Phone:575-437-2453
Practice Address - Fax:575-443-1504
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB3399104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker