MEDICARE: MS. CAROL RUTH NEWMAN LP

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	103T00000X	Psychologist	LP3321	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6256700	OTHER	MN	UNITED BEHAVIORAL HEALTH
2	287T4NE	OTHER	MN	BCBS OF MN PROVIDER
3	87766	OTHER	MN	HEALTH PARTNERS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	98556	OTHER	MN	MAYO (MMSI)
6	118235	OTHER	MN	UCARE
7	287T5NE	OTHER	MN	BCBS OF MN INDIVIDUAL

General Provider Information

NPI Number	:	1770690083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL RUTH NEWMAN LP

Provider Business Mailing Address
First Line	:	855 VILLAGE CENTER DR # 359
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55127-3016
Country	:	US
Telephone Number	:	218-429-5282
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 MARTHA LAKE COURT
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55126
Country	:	US
Telephone Number	:	218-429-5282
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	11/03/2023

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