Provider Demographics
NPI:1568181881
Name:NEWA, KELSEY CLAIRE (LLMSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:CLAIRE
Last Name:NEWA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29750 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2607
Mailing Address - Country:US
Mailing Address - Phone:586-777-3200
Mailing Address - Fax:586-777-7855
Practice Address - Street 1:29750 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2607
Practice Address - Country:US
Practice Address - Phone:586-777-3200
Practice Address - Fax:586-777-3200
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 390200000X
MI68511165221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
3135306637OtherN/A