Provider Demographics
NPI:1427370014
Name:NEWKIRK-SANBORN, SUSAN WALDRON (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WALDRON
Last Name:NEWKIRK-SANBORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 ARSENAL ST.
Mailing Address - Street 2:11 STATE HOUSE STATION
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04333-0011
Mailing Address - Country:US
Mailing Address - Phone:207-624-4657
Mailing Address - Fax:207-287-6123
Practice Address - Street 1:250 ARSENAL ST.
Practice Address - Street 2:11 STATE HOUSE STATION
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0011
Practice Address - Country:US
Practice Address - Phone:207-624-3961
Practice Address - Fax:207-287-6123
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS377103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist