Healthcare Provider Details

I. General information

NPI: 1902093164
Provider Name (Legal Business Name): RISA E. NEWELL, PH.D., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 N TATUM BLVD SUITE 103
PHOENIX AZ
85028-1607
US

IV. Provider business mailing address

11110 N TATUM BLVD SUITE 103
PHOENIX AZ
85028-1607
US

V. Phone/Fax

Practice location:
  • Phone: 602-478-1477
  • Fax: 602-443-0400
Mailing address:
  • Phone: 602-478-1477
  • Fax: 602-443-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3330
License Number StateAZ

VIII. Authorized Official

Name: DR. LARISA EUBANK NEWELL
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 602-478-1477