Basic Information
Provider Information
NPI: 1457027831
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEW
FirstName: CHRISTINA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1402 RACE ST APT 107
Address2:  
City: DENVER
State: CO
PostalCode: 802062032
CountryCode: US
TelephoneNumber: 4435977893
FaxNumber:  
Practice Location
Address1: 13001 E 17TH PL
Address2:  
City: AURORA
State: CO
PostalCode: 800452570
CountryCode: US
TelephoneNumber: 3037241000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2021
LastUpdateDate: 12/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X  N Behavioral Health & Social Service ProvidersPsychologist 
103TC0700XPSY.0005672COY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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