Healthcare Provider Details

I. General information

NPI: 1578041083
Provider Name (Legal Business Name): LISA MARIE NEWBERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W MISSION AVE STE 106
ESCONDIDO CA
92025-1603
US

IV. Provider business mailing address

29747 MILLER RD
VALLEY CENTER CA
92082-5829
US

V. Phone/Fax

Practice location:
  • Phone: 619-281-3706
  • Fax: 760-796-4397
Mailing address:
  • Phone: 760-468-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105615
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: