Provider Demographics
NPI:1619703683
Name:NEWSOME, STEPHANI (EDS, NCSP)
Entity type:Individual
Prefix:
First Name:STEPHANI
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:MRS
Other - First Name:STEPHANI
Other - Middle Name:
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, EDS, NCSP
Mailing Address - Street 1:5865 E 50 S
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-8731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5865 E 50 S
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8731
Practice Address - Country:US
Practice Address - Phone:765-772-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10188192103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool