1740237080 NPI number — KIMBERLY A NEWBURY LICSW

Table of content: KIMBERLY A NEWBURY LICSW (NPI 1740237080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740237080 NPI number — KIMBERLY A NEWBURY LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWBURY
Provider First Name:
KIMBERLY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740237080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 899
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02813-0899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-364-7705
Provider Business Mailing Address Fax Number:
401-364-9104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4705A OLD POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02813-1819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-364-7705
Provider Business Practice Location Address Fax Number:
401-364-9104
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  ISW01145 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 341613 . This is a "MHN/TRICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 408126 . This is a "RI BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: KA09594 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1020890 . This is a "BEACON" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 30616-8 . This is a "RI BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 62-09370 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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