Healthcare Provider Details

I. General information

NPI: 1720061872
Provider Name (Legal Business Name): DENISE ELLEN NEWMAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 STATE ROUTE 209
MILLERSBURG PA
17061-8002
US

IV. Provider business mailing address

RR 1 BOX 1054 OLD STONEHOUSE ROAD
HERNDON PA
17830-9770
US

V. Phone/Fax

Practice location:
  • Phone: 717-692-5294
  • Fax:
Mailing address:
  • Phone: 570-758-2987
  • Fax: 570-758-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005748L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: