MEDICARE: MRS. KRISTI ANN NEWHOUSE LCSW

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	1041C0700X	Clinical Social Worker	SW8373	FL

General Provider Information

NPI Number	:	1134265002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTI ANN NEWHOUSE LCSW

Provider Business Mailing Address
First Line	:	2528 SW 26TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-3823
Country	:	US
Telephone Number	:	239-549-7043
Fax Number	:	239-549-7043

Provider Business Practice Location Address
First Line	:	3900 BROADWAY
Second Line	:	SUITE B-1
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8193
Country	:	US
Telephone Number	:	239-939-2808
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/07/2007

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