Healthcare Provider Details

I. General information

NPI: 1497384812
Provider Name (Legal Business Name): NEAL ALLEN NEWFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 MAPLE DR # 1
MORGANTOWN WV
26505-0387
US

IV. Provider business mailing address

1063 MAPLE DR # 1
MORGANTOWN WV
26505-0387
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-5751
  • Fax:
Mailing address:
  • Phone: 304-599-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00851796
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: