Active NPI
Lisa A McTavis, PMSW
- Social Worker
- Albuquerque, NM
National Provider Identifier
1891132346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- M-08387
- Practice address
- 2551 Coors Blvd NW
Albuquerque, NM 87120-1213 - Phone
- (505) 338-3320
- NPI assigned
- May 23, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | X-08111 | NM | |
| Social Worker | 104100000X | M-08387 | NM | Primary |
Addresses
Primary practice location
2551 Coors Blvd NW
Albuquerque, NM 87120-1213
Mailing address
2551 Coors Blvd NW
Albuquerque, NM 87120-1213
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-08387 | NM | MD | Social Worker |
| X-08111 | NM | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423094400000",
"number": "1891132346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2551 COORS BLVD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871201213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2551 COORS BLVD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871201213",
"telephone_number": "505-338-3320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCTAVIS",
"first_name": "LISA",
"middle_name": "A",
"credential": "PMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-23",
"last_updated": "2015-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "X-08111",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NM",
"license": "M-08387",
"primary": true
}
],
"identifiers": [],
"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 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.