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NPI Code Detail

MEDICARE: SUPPORTIVE CARE OF NEW MEXICO LLC

MEDICARE: SUPPORTIVE CARE OF NEW MEXICO LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
2363L00000XNurse Practitioner
3103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1548110133
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPPORTIVE CARE OF NEW MEXICO LLC
Provider Business Mailing Address
First Line : 27 RANDOLPH RD
Second Line :
City : HOWELL
State : NJ
Zip : 07731-8611
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 SAGUARO TRL
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-9632
Country : US
Telephone Number : 718-506-1115
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : RAPHAEL LICHTSCHEIN
Credential :
Telephone Number : 718-298-4375
Provider Enumeration Date : 02/02/2026
Last Update Date : 02/02/2026

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Directions to “SUPPORTIVE CARE OF NEW MEXICO LLC ” Practice Location

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