Provider Demographics
NPI:1417047770
Name:NEWBERRY, ALICE M (PHD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:NEWBERRY
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 1:521 SKYWAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-1419
Mailing Address - Country:US
Mailing Address - Phone:970-243-7165
Mailing Address - Fax:970-241-4997
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:SUITE 312
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2470
Practice Address - Country:US
Practice Address - Phone:970-263-4822
Practice Address - Fax:970-491-4997
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2255103T00000X
UT117425-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68576Medicare ID - Type Unspecified