MEDICARE: EMILY NEWBERG

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	374J00000X	Doula

General Provider Information

NPI Number	:	1063862209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY NEWBERG

Provider Business Mailing Address
First Line	:	260 WAVERLEY AVE # 3
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-3208
Country	:	US
Telephone Number	:	617-575-9420
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 WAVERLEY AVE # 3
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-3208
Country	:	US
Telephone Number	:	617-575-9420
Fax Number	:

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

Provider Enumeration Date	:	06/19/2016
Last Update Date	:	06/19/2016

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Directions to “ EMILY NEWBERG ” Practice Location

Language	Start Address	Practice Location

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