MEDICARE: NATE NEWMAN PH D BCD LCSW PC

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	251S00000X	Community/Behavioral Health Agency	LCS10217	CA

General Provider Information

NPI Number	:	1225271240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATE NEWMAN PH D BCD LCSW PC

Provider Business Mailing Address
First Line	:	4055 THOUSAND OAKS BLVD
Second Line	:	SUITE 215
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3600
Country	:	US
Telephone Number	:	818-596-2069
Fax Number	:	818-225-9755

Provider Business Practice Location Address
First Line	:	4055 THOUSAND OAKS BLVD
Second Line	:	SUITE 215
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3600
Country	:	US
Telephone Number	:	818-596-2069
Fax Number	:	818-225-9755

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NATE NEWMAN
Credential	:	PH.D.
Telephone Number	:	818-596-2069

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/22/2010

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