MEDICARE: DR. KRISTEN M NEWBERRY PSY.D.

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	103TC0700X	Clinical Psychologist	071.008644	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	071.008644	OTHER	IL	CLINICAL PSYCHOLOGIST, LICENSE

General Provider Information

NPI Number	:	1912152661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN M NEWBERRY PSY.D.

Provider Business Mailing Address
First Line	:	2005 BLOOMINGDALE RD STE B
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2151
Country	:	US
Telephone Number	:	630-383-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 BLOOMINGDALE RD STE B
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2151
Country	:	US
Telephone Number	:	630-383-7222
Fax Number	:

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

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	06/29/2021

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