Provider Demographics
NPI:1457335606
Name:ARGE, LISA C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:C
Last Name:ARGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 SOUTHERN BLVD SE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3797
Mailing Address - Country:US
Mailing Address - Phone:505-880-0100
Mailing Address - Fax:505-994-0162
Practice Address - Street 1:2218 SOUTHERN BLVD SE
Practice Address - Street 2:SUITE 14
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3797
Practice Address - Country:US
Practice Address - Phone:505-880-0100
Practice Address - Fax:505-994-0162
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1024103T00000X
MA8224103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA346821OtherMHN
MA469932OtherTUFTS
NM1024OtherSTATE LICENSE
MAW06331OtherBCBSMA
MA043476807-12OtherPACIFICARE
NH06Y007852MA01OtherBCBSNH
MAW51305Medicare ID - Type Unspecified