MEDICARE: DEANNE KREIS NEWMAN MSW

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	104100000X	Social Worker	I0462	NM

General Provider Information

NPI Number	:	1104968379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNE KREIS NEWMAN MSW

Provider Business Mailing Address
First Line	:	1626 PASEO DE PERALTA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-3724
Country	:	US
Telephone Number	:	505-988-5033
Fax Number	:	505-988-5619

Provider Business Practice Location Address
First Line	:	1626 PASEO DE PERALTA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-3724
Country	:	US
Telephone Number	:	505-988-5033
Fax Number	:	505-988-5619

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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