Provider Demographics
NPI:1003118761
Name:NEWMAN, GREG (LCSW)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MOLALLA AVE
Mailing Address - Street 2:SUITE 229
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3788
Mailing Address - Country:US
Mailing Address - Phone:503-722-4110
Mailing Address - Fax:
Practice Address - Street 1:1001 MOLALLA AVE
Practice Address - Street 2:SUITE 229
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-3788
Practice Address - Country:US
Practice Address - Phone:503-722-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL42191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1104253079Medicaid