Provider Demographics
NPI:1518540004
Name:NEWSOME, CAROLINE THERESA
Entity Type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:THERESA
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S RYAN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5537
Mailing Address - Country:US
Mailing Address - Phone:334-707-4391
Mailing Address - Fax:
Practice Address - Street 1:6951 PISTOL RANGE RD STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9642
Practice Address - Country:US
Practice Address - Phone:813-696-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1OtherN/A