Provider Demographics
NPI:1861675589
Name:NEWMAN, JANE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ANN
Last Name:NEWMAN
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 1:1014 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MANUEL
Mailing Address - State:AZ
Mailing Address - Zip Code:85631-1205
Mailing Address - Country:US
Mailing Address - Phone:520-385-4328
Mailing Address - Fax:
Practice Address - Street 1:1014 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAN MANUEL
Practice Address - State:AZ
Practice Address - Zip Code:85631-1205
Practice Address - Country:US
Practice Address - Phone:520-385-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ729866Medicaid