Provider Demographics
NPI:1174680797
Name:NEWMAN, LISA JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JOY
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WEDGE RD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-3315
Mailing Address - Country:US
Mailing Address - Phone:518-439-3368
Mailing Address - Fax:
Practice Address - Street 1:413 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-3231
Practice Address - Country:US
Practice Address - Phone:518-242-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8634103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01605678Medicaid
NY01605678Medicaid