MEDICARE: ALYSSA NEWMAN LLMSW

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	LG200002863	DC
2	1041C0700X	Clinical Social Worker	6851120470	MI

General Provider Information

NPI Number	:	1861369373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA NEWMAN LLMSW

Provider Business Mailing Address
First Line	:	18030 PENNINGTON DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2637
Country	:	US
Telephone Number	:	734-673-6414
Fax Number	:

Provider Business Practice Location Address
First Line	:	42450 GARFIELD RD STE F
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5040
Country	:	US
Telephone Number	:	586-421-4513
Fax Number	:

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

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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