MEDICARE: MARY KATHLEEN NEWMAN LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	5376	KS
2	104100000X	Social Worker	4125	KS

General Provider Information

NPI Number	:	1306025317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHLEEN NEWMAN LMSW

Provider Business Mailing Address
First Line	:	4601 E DOUGLAS AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-1011
Country	:	US
Telephone Number	:	785-608-8429
Fax Number	:	844-811-6367

Provider Business Practice Location Address
First Line	:	4601 E DOUGLAS AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-1011
Country	:	US
Telephone Number	:	785-608-8429
Fax Number	:	844-811-6367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	12/10/2019

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