Provider Demographics
NPI:1720862048
Name:CLAIRE, EDWINA
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:
Last Name:CLAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ARCHULETA RD
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-9781
Mailing Address - Country:US
Mailing Address - Phone:575-999-1865
Mailing Address - Fax:
Practice Address - Street 1:1333 PASEO DEL PUEBLO SUR
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5972
Practice Address - Country:US
Practice Address - Phone:575-224-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor