Individual
DR. LISA C ARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2218 SOUTHERN BLVD SE, SUITE 14, RIO RANCHO, NM 87124-3797
(505) 880-0100
(505) 994-0162
Mailing address
2218 SOUTHERN BLVD SE, SUITE 14, RIO RANCHO, NM 87124-3797
(505) 880-0100
(505) 994-0162
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1024
NM
103T00000X
Psychologist
Primary
8224
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043476807-12
PACIFICARE
MA
01
—
06Y007852MA01
BCBSNH
NH
01
—
1024
STATE LICENSE
NM
01
—
346821
MHN
MA
01
—
469932
TUFTS
MA
01
—
W06331
BCBSMA
MA
Enumeration date
12/01/2005
Last updated
01/10/2011
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