Provider Demographics
NPI:1437213899
Name:DAVIDGE, KATHERINE GENEVIEVE (LISW)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:GENEVIEVE
Last Name:DAVIDGE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 CARLISLE BLVD NE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1679
Mailing Address - Country:US
Mailing Address - Phone:505-830-6030
Mailing Address - Fax:505-830-6031
Practice Address - Street 1:3150 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 22
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1679
Practice Address - Country:US
Practice Address - Phone:505-830-6030
Practice Address - Fax:505-830-6031
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-18531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8476675OtherLOVELACE HEALTH PLAN
NM95656Medicaid
NM011647OtherVALUEOPTIONS
NM028431000OtherMAGELLAN HEALTH SERVICES
NM201002251OtherPRESBYTERIAN INSURANCE CO
NMNM101514OtherVALUEOPTIONS NEW MEXICO
NMNM00R36TOtherBCBS