Provider Demographics
NPI:1194049783
Name:NEWSOME, FAYE (LP)
Entity type:Individual
Prefix:MS
First Name:FAYE
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:LP
Other - Prefix:MRS
Other - First Name:FAYE
Other - Middle Name:NEWSOME
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 W 90 ST.
Mailing Address - Street 2:SUITE 21F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-362-0514
Mailing Address - Fax:212-362-0514
Practice Address - Street 1:65 W 90 ST.
Practice Address - Street 2:SUITE 21F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-362-0514
Practice Address - Fax:212-362-0514
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000329-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst