Provider Demographics
NPI:1720470404
Name:CLAIRE THOMAS-DUCKWITZ, PH.D. LLC
Entity type:Organization
Organization Name:CLAIRE THOMAS-DUCKWITZ, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MBR
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS-DUCKWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-660-8346
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-0051
Mailing Address - Country:US
Mailing Address - Phone:719-660-8346
Mailing Address - Fax:866-757-5778
Practice Address - Street 1:2350 17TH AVENUE
Practice Address - Street 2:UNIT 104
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503
Practice Address - Country:US
Practice Address - Phone:719-660-8346
Practice Address - Fax:866-757-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4035103T00000X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06108768Medicaid