Provider Demographics
NPI:1457330508
Name:NEWBY, NANCY J (MA)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:NEWBY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 CARDINAL CREEK PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8468
Mailing Address - Country:US
Mailing Address - Phone:407-671-7005
Mailing Address - Fax:407-671-7005
Practice Address - Street 1:1185 CARDINAL CREEK PL
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8468
Practice Address - Country:US
Practice Address - Phone:407-671-7005
Practice Address - Fax:407-671-7005
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3580101YM0800X
CAMFC 23686106H00000X
CO179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ016XOtherBCBS
FLZ016XOtherBCBS