Healthcare Provider Details

I. General information

NPI: 1356742191
Provider Name (Legal Business Name): MATTHEW NEWBURY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/07/2022
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S TAMARAC DR
DENVER CO
80231-4360
US

IV. Provider business mailing address

11235 E ALAMEDA AVE APT 12
AURORA CO
80012-1010
US

V. Phone/Fax

Practice location:
  • Phone: 303-597-5000
  • Fax:
Mailing address:
  • Phone: 801-663-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09925581
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: