Healthcare Provider Details

I. General information

NPI: 1629049218
Provider Name (Legal Business Name): DIANA LYNN NEWBERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 W 6200 S
KEARNS UT
84118-3749
US

IV. Provider business mailing address

94 NORTH PINE CREEK DRIVE
WEST POINT UT
84015
US

V. Phone/Fax

Practice location:
  • Phone: 801-955-9686
  • Fax: 801-965-8789
Mailing address:
  • Phone: 801-773-7441
  • Fax: 801-773-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5419961-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: