Healthcare Provider Details

I. General information

NPI: 1588718449
Provider Name (Legal Business Name): KATHRYN NEWTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 OSO COURT
SANTA FE NM
87507
US

IV. Provider business mailing address

PO BOX 9276
SANTA FE NM
87504-9276
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-6044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-2363
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: