Provider Demographics
NPI:1154538817
Name:NEWTON, VIRGINIA MORRISON (PSYD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MORRISON
Last Name:NEWTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 MARIPOSA AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7841
Mailing Address - Country:US
Mailing Address - Phone:303-444-4966
Mailing Address - Fax:720-565-8299
Practice Address - Street 1:2027 11TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5101
Practice Address - Country:US
Practice Address - Phone:303-444-4966
Practice Address - Fax:303-545-9803
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2686103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO514728Medicare ID - Type UnspecifiedPSYCHOLOGIST