Provider Demographics
NPI:1528226537
Name:NEWMAN, TINA MICHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MICHELLE
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 1:2300 MAIN STREET
Mailing Address - Street 2:CCSN
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-430-1762
Mailing Address - Fax:860-430-2648
Practice Address - Street 1:2300 MAIN STREET
Practice Address - Street 2:CCSN
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-430-1762
Practice Address - Fax:860-430-2648
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002613103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent