MEDICARE: CYNTHIA A NEWTON 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	36053	TX

General Provider Information

NPI Number	:	1780990945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA A NEWTON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 99213
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76199-0213
Country	:	US
Telephone Number	:	682-885-4871
Fax Number	:	682-885-3639

Provider Business Practice Location Address
First Line	:	6421 MCCART AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4702
Country	:	US
Telephone Number	:	817-263-7500
Fax Number	:	817-423-4140

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

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	08/26/2010

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