Healthcare Provider Details

I. General information

NPI: 1700933058
Provider Name (Legal Business Name): TERI ELLEN NEWMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 JAQUES AVE
WORCESTER MA
01610-2476
US

IV. Provider business mailing address

226 SWANSON RD UNIT 614
BOXBOROUGH MA
01719-1325
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-1095
  • Fax:
Mailing address:
  • Phone: 978-635-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number200529
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: