Provider Demographics
NPI:1548304587
Name:NEWSOM, EDY (EDITH) R (MS)
Entity type:Individual
Prefix:MS
First Name:EDY (EDITH)
Middle Name:R
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 BARROW ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3632
Mailing Address - Country:US
Mailing Address - Phone:907-562-1892
Mailing Address - Fax:907-297-1236
Practice Address - Street 1:717 BARROW ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3632
Practice Address - Country:US
Practice Address - Phone:907-562-1892
Practice Address - Fax:907-297-1236
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist