MEDICARE: DR. LYNDA W NEWMAN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	21951	TX
2	103TC0700X	Clinical Psychologist	21951	TX
3	103TC2200X	Clinical Child & Adolescent Psychologist	21951	TX

General Provider Information

NPI Number	:	1043492945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNDA W NEWMAN PHD

Provider Business Mailing Address
First Line	:	6390 LBJ FREEWAY
Second Line	:	SUITE 107
City	:	DALLAS
State	:	TX
Zip	:	75240
Country	:	US
Telephone Number	:	972-239-9015
Fax Number	:

Provider Business Practice Location Address
First Line	:	6390 LBJ FREEWAY
Second Line	:	SUITE 107
City	:	DALLAS
State	:	TX
Zip	:	75240
Country	:	US
Telephone Number	:	972-239-9015
Fax Number	:	972-239-4760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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