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General NPI Number Information
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NPI Number | 1427354851
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Entity Type | Individual
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Provider Name | CAROLYN BERG NEWSOME M.A.
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Gender | Female
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 2060 W.WHISPERING WIND DRIVE
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City | PHOENIX
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State | AZ
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Zip | 85085
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Country | US
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Telephone | 623-551-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 1732 W MOHAWK LN
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City | PHOENIX
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State | AZ
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Zip | 85027-3511
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Country | US
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Telephone | 623-780-9904
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Fax | 928-684-4830
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT10248
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License Number State | AZ
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