Provider Demographics
NPI:1225314263
Name:NEWMAN, CRYSTAL W (PHD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:W
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 1:612 W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-3945
Mailing Address - Country:US
Mailing Address - Phone:732-513-5455
Mailing Address - Fax:
Practice Address - Street 1:301 N NEIL ST STE 210
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3166
Practice Address - Country:US
Practice Address - Phone:217-244-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3270591Medicare PIN