Provider Demographics
NPI:1114469426
Name:BILLUPS-NEWTON, GWEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GWEN
Middle Name:
Last Name:BILLUPS-NEWTON
Suffix:
Gender:F
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:PO BOX 123
Mailing Address - Street 2:FALLSBURG CENTRAL SCH. DIST.
Mailing Address - City:FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12733
Mailing Address - Country:US
Mailing Address - Phone:845-434-6800
Mailing Address - Fax:845-434-0871
Practice Address - Street 1:15 OLD FALLS ROAD
Practice Address - Street 2:BENJAMIN COSON ELEMENTARY
Practice Address - City:FALLSBURG
Practice Address - State:NY
Practice Address - Zip Code:12733
Practice Address - Country:US
Practice Address - Phone:845-434-4110
Practice Address - Fax:845-434-0871
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730781461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical