{
"Npi": {
"NPI": "1669034385",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DAVIS",
"FirstName": "AIDEN",
"MiddleName": "FELIZ",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DAVIS",
"OtherFirstName": "AMANDA",
"OtherMiddleName": "FELIZ",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5201 VENICE AVE NE STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALBUQUERQUE",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87113-2337",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-916-2007",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6330 RIVERSIDE PLAZA LN NW STE 260",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALBUQUERQUE",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "87120-2160",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-226-2839",
"PracticeLocationAddressFaxNumber": "505-295-2559",
"EnumerationDate": "07/02/2019",
"LastUpdateDate": "08/28/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "M-10800",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "SWB-2022-0987",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}