Healthcare Provider Details

I. General information

NPI: 1245616002
Provider Name (Legal Business Name): SARAH JANE TARANGO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N MAIN ST STE 6
LAS CRUCES NM
88001-1136
US

IV. Provider business mailing address

3140 ARROWHEAD RD
LAS CRUCES NM
88011-4783
US

V. Phone/Fax

Practice location:
  • Phone: 575-202-6317
  • Fax:
Mailing address:
  • Phone: 575-202-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10479
License Number StateNM

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: