Healthcare Provider Details

I. General information

NPI: 1871157313
Provider Name (Legal Business Name): LYNNE GUMENICK NEWMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 W BIG BEAVER RD STE 520
TROY MI
48084-3442
US

IV. Provider business mailing address

8840 HUNTINGTON RD
HUNTINGTON WOODS MI
48070-1647
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-6659
  • Fax: 248-642-8645
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801073057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: