Provider Demographics
NPI:1205180494
Name:NEWELL, THERESA (PSYD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:NEWELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 N FEDERAL HWY
Mailing Address - Street 2:SUITE #42
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5187
Mailing Address - Country:US
Mailing Address - Phone:954-981-8200
Mailing Address - Fax:954-272-8043
Practice Address - Street 1:3595 SHERIDAN ST
Practice Address - Street 2:SUITE #103
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3657
Practice Address - Country:US
Practice Address - Phone:954-981-8200
Practice Address - Fax:954-272-8043
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8615103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist