Provider Demographics
NPI:1073004990
Name:NEWTON, AMY (PSYD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:NIKITENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2870 KAISER DR APT 205
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7507
Mailing Address - Country:US
Mailing Address - Phone:760-533-1307
Mailing Address - Fax:
Practice Address - Street 1:2500 GRANT RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4302
Practice Address - Country:US
Practice Address - Phone:760-533-1307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29992103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical