MEDICARE: MR. JOSHUA NEWBURY CSW, 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	1041C0700X	Clinical Social Worker	8346809-3502	UT

General Provider Information

NPI Number	:	1588910871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSHUA NEWBURY CSW, MSW

Provider Business Mailing Address
First Line	:	739 S 300 W UNIT 203
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2618
Country	:	US
Telephone Number	:	801-459-9809
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3613
Country	:	US
Telephone Number	:	801-467-7280
Fax Number	:

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

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	09/23/2014

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