Active NPI
Denise M Raven, LISW
- Clinical Social Worker
- Albuquerque, NM
National Provider Identifier
1477675460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I-04926
- Practice address
- 2917 Carlisle Blvd NE Ste 105
Albuquerque, NM 87110-2489 - Phone
- (505) 269-0212
- Fax
- (505) 312-8684
- NPI assigned
- Apr 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I-04926 | NM | Primary |
Addresses
Primary practice location
2917 Carlisle Blvd NE Ste 105
Albuquerque, NM 87110-2489
Mailing address
2917 Carlisle Blvd NE Ste 105
Albuquerque, NM 87110-2489
Phone (505) 269-0212
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 81006853 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2025 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I-04926 | NM | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600300800000",
"number": "1477675460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2917 CARLISLE BLVD NE STE 105",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871102489",
"telephone_number": "505-269-0212",
"fax_number": "505-312-8684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2917 CARLISLE BLVD NE STE 105",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871102489",
"telephone_number": "505-269-0212",
"fax_number": "505-312-8684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAVEN",
"first_name": "DENISE",
"middle_name": "M",
"credential": "LISW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-03",
"last_updated": "2020-09-17",
"certification_date": "2020-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "I-04926",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "81006853",
"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 Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.