Provider Demographics
NPI:1225761133
Name:NEWBERRY, MATTHEW MCNEILL
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MCNEILL
Last Name:NEWBERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 NE OREGON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2511
Mailing Address - Country:US
Mailing Address - Phone:202-270-3417
Mailing Address - Fax:
Practice Address - Street 1:2104 SE MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2825
Practice Address - Country:US
Practice Address - Phone:971-285-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health