Provider Demographics
NPI:1588037170
Name:NEWDECK, MICHELLE (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NEWDECK
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DALE LN
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1203
Mailing Address - Country:US
Mailing Address - Phone:215-353-7585
Mailing Address - Fax:
Practice Address - Street 1:928 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4226
Practice Address - Country:US
Practice Address - Phone:215-923-4202
Practice Address - Fax:214-923-4751
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007535101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor