NPIMap

Organization Active NPI

Sage Bear Counseling, LLC

  • Clinical Social Worker
  • Albuquerque, NM
National Provider Identifier
1114385952
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C-1853 Issued in NM
Legal business name
SAGE BEAR COUNSELING, LLC
Practice address
3150 Carlisle Blvd NE
Suite 22
Albuquerque, NM 87110-1678
Phone
(505) 830-6030
Fax
(505) 830-6031
NPI assigned
Feb 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Katherine Genevieve Davidge, LCSWNPI 1437213899
Title
Licensed Clinical Social Worker
Phone
(505) 830-6030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X C-1853 NM Primary

Addresses

Primary practice location

3150 Carlisle Blvd NE
Suite 22
Albuquerque, NM 87110-1678

Mailing address

3150 Carlisle Blvd NE
Suite 22
Albuquerque, NM 87110-1678
Phone (505) 830-6030

Other identifiers 1

IdentifierTypeStateIssuer
95656MedicaidNM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455235200000",
    "number": "1114385952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 CARLISLE BLVD NE",
            "address_2": "SUITE 22",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871101678",
            "telephone_number": "505-830-6030",
            "fax_number": "505-830-6031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 CARLISLE BLVD NE",
            "address_2": "SUITE 22",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871101678",
            "telephone_number": "505-830-6030",
            "fax_number": "505-830-6031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE BEAR COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-08",
        "last_updated": "2016-02-12",
        "status": "A",
        "authorized_official_last_name": "DAVIDGE",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "GENEVIEVE",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "505-830-6030",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-1853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95656",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.