Provider Demographics
NPI:1699739623
Name:NEWSOM, PAIGE DENISE (LCSW)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:DENISE
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667A EMORY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7765
Mailing Address - Country:US
Mailing Address - Phone:865-482-1778
Mailing Address - Fax:865-482-9488
Practice Address - Street 1:667A EMORY VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7765
Practice Address - Country:US
Practice Address - Phone:865-482-1778
Practice Address - Fax:865-482-9488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000009551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3920730Medicaid
TN3920730Medicare ID - Type Unspecified
TN3920730Medicaid