Healthcare Provider Details

I. General information

NPI: 1902020787
Provider Name (Legal Business Name): JOHN DAVID NEWMARK M.S. , LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 IVES DAIRY RD BLDG.5 , SUITE 138
NORTH MIAMI BEACH FL
33179-2539
US

IV. Provider business mailing address

6710 BULL RUN RD APT 263
MIAMI LAKES FL
33014-8100
US

V. Phone/Fax

Practice location:
  • Phone: 305-493-1190
  • Fax: 305-493-1191
Mailing address:
  • Phone: 305-493-1190
  • Fax: 305-493-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 7821
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: