Provider Demographics
NPI:1306945449
Name:CLAMPET, OCTAVIA ROGERS (LCSW)
Entity type:Individual
Prefix:MS
First Name:OCTAVIA
Middle Name:ROGERS
Last Name:CLAMPET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BRIDAL FALLS LANE
Mailing Address - Street 2:
Mailing Address - City:TULAROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88352
Mailing Address - Country:US
Mailing Address - Phone:575-430-1174
Mailing Address - Fax:
Practice Address - Street 1:53 BRIDAL FALLS LANE
Practice Address - Street 2:
Practice Address - City:TULAROSA
Practice Address - State:NM
Practice Address - Zip Code:88352
Practice Address - Country:US
Practice Address - Phone:575-430-1174
Practice Address - Fax:575-208-7255
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TX40484104100000X
NMC-04974104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker