Provider Demographics
NPI:1346721487
Name:NEWKIRK, TONJA (LMHC-P)
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:
Last Name:NEWKIRK
Suffix:
Gender:F
Credentials:LMHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 ABBOTT RD STE 500
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1069
Mailing Address - Country:US
Mailing Address - Phone:716-822-2177
Mailing Address - Fax:716-822-8165
Practice Address - Street 1:227 THORN AVE
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2600
Practice Address - Country:US
Practice Address - Phone:716-662-2040
Practice Address - Fax:716-662-0019
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007455-01101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1346721487Medicaid