Provider Demographics
NPI:1316305717
Name:NEWDELMAN, JODIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JODIE
Middle Name:
Last Name:NEWDELMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JODIE
Other - Middle Name:M
Other - Last Name:NEWDELMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:SAN GERONIMO
Mailing Address - State:CA
Mailing Address - Zip Code:94963-0083
Mailing Address - Country:US
Mailing Address - Phone:415-717-2626
Mailing Address - Fax:
Practice Address - Street 1:907 4TH STREET
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-488-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27963103T00000X, 103TC0700X
103TH0004X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy