Healthcare Provider Details

I. General information

NPI: 1972272094
Provider Name (Legal Business Name): NEWT RUSSELL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 EAGLE DR
OHKAY OWINGEH NM
87566-3600
US

IV. Provider business mailing address

327 EAGLE DR
OHKAY OWINGEH NM
87566-3600
US

V. Phone/Fax

Practice location:
  • Phone: 505-901-3152
  • Fax: 505-852-1378
Mailing address:
  • Phone: 505-692-4808
  • Fax: 505-852-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1201
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-1153
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: