Healthcare Provider Details

I. General information

NPI: 1285034942
Provider Name (Legal Business Name): BENJAMIN SEAN NEWMAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2014
Last Update Date: 09/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17579 WARWICK BLVD
NEWPORT NEWS VA
23603-1343
US

IV. Provider business mailing address

17579 WARWICK BLVD
NEWPORT NEWS VA
23603-1343
US

V. Phone/Fax

Practice location:
  • Phone: 757-888-0400
  • Fax: 757-887-3331
Mailing address:
  • Phone: 757-888-0400
  • Fax: 757-887-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701005314
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0701005314
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number0701005314
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: