Provider Demographics
NPI:1538933734
Name:NEWTON, MARIAM FAITH
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:FAITH
Last Name:NEWTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1613
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-1613
Mailing Address - Country:US
Mailing Address - Phone:352-219-0456
Mailing Address - Fax:
Practice Address - Street 1:16655 NW COUNTY ROAD 339
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-8458
Practice Address - Country:US
Practice Address - Phone:352-565-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral