MEDICARE: JANUARY LEE NEWPORT LSW, LICDC

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	1041C0700X	Clinical Social Worker	S.2309767	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	.162905	OH

General Provider Information

NPI Number	:	1710477427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANUARY LEE NEWPORT LSW, LICDC

Provider Business Mailing Address
First Line	:	100 ELMWOOD PARK DR
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ELMWOOD PARK DR
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:	937-384-0580
Fax Number	:

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

Provider Enumeration Date	:	05/17/2018
Last Update Date	:	01/13/2026

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