Healthcare Provider Details

I. General information

NPI: 1316829781
Provider Name (Legal Business Name): CLINTON NEWMAN III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date: 11/29/2025
Reactivation Date: 12/09/2025

III. Provider practice location address

PO BOX 360595
PITTSBURGH PA
15251-6595
US

IV. Provider business mailing address

PO BOX 360595
PITTSBURGH PA
15251-6595
US

V. Phone/Fax

Practice location:
  • Phone: 718-215-5311
  • Fax: 718-865-5165
Mailing address:
  • Phone: 718-215-5411
  • Fax: 718-865-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1316829781
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: