Healthcare Provider Details

I. General information

NPI: 1538774880
Provider Name (Legal Business Name): OLIVIA SUMMA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 W CHURCH ST STE 318
NEWARK OH
43055-5050
US

IV. Provider business mailing address

3304 JAMES ST
SANTA FE NM
87507-5019
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-8962
  • Fax:
Mailing address:
  • Phone: 505-699-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2023-0077
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08638
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: