Active NPI
Maurine R. Renville, LISW
- Clinical Social Worker
- Albuquerque, NM
National Provider Identifier
1548275332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I-3985
- Practice address
- 1330 Lomas Blvd NW
Albuquerque, NM 87104-1234 - Phone
- (505) 766-5363
- NPI assigned
- Jul 30, 2006
- 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-3985 | NM | Primary |
Addresses
Primary practice location
1330 Lomas Blvd NW
Albuquerque, NM 87104-1234
Mailing address
1330 Lomas Blvd NW
Albuquerque, NM 87104-1234
Phone (505) 766-5363
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201008219 | Other | NM | PRESBYTERIAN HEALTH CARE |
| NM101564 | Medicaid | NM | |
| 79994 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222560000000",
"number": "1548275332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1330 LOMAS BLVD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871041234",
"telephone_number": "505-766-5363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1330 LOMAS BLVD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871041234",
"telephone_number": "505-766-5363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENVILLE",
"first_name": "MAURINE",
"middle_name": "R.",
"name_prefix": "Ms.",
"credential": "LISW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-30",
"last_updated": "2008-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "I-3985",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRESBYTERIAN HEALTH CARE",
"identifier": "201008219",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NM101564",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "79994",
"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 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.