Provider Demographics
NPI:1447563580
Name:NEWMAN, STEPHANIE RANDOLPH (MS, LCPC, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RANDOLPH
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MS, LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-0980
Mailing Address - Country:US
Mailing Address - Phone:410-535-3079
Mailing Address - Fax:410-535-2220
Practice Address - Street 1:975 SOLOMONS ISLAND RD N
Practice Address - Street 2:SUITE 119
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3917
Practice Address - Country:US
Practice Address - Phone:410-535-5400
Practice Address - Fax:410-535-2220
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6333101YM0800X
MDLCA2236101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3322998 00Medicaid