Provider Demographics
NPI:1174033047
Name:NEWALL, JAMIE NICHOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:NICHOLE
Last Name:NEWALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:NICHOLE
Other - Last Name:VESCIGLIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:99 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2509
Mailing Address - Country:US
Mailing Address - Phone:203-400-8199
Mailing Address - Fax:
Practice Address - Street 1:99 ELM ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2509
Practice Address - Country:US
Practice Address - Phone:203-400-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT105671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid