Provider Demographics
NPI:1629049218
Name:NEWBERRY, DIANA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNN
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 NORTH PINE CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84015
Mailing Address - Country:US
Mailing Address - Phone:801-773-7441
Mailing Address - Fax:801-773-7441
Practice Address - Street 1:3703 W 6200 S
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-3749
Practice Address - Country:US
Practice Address - Phone:801-955-9686
Practice Address - Fax:801-965-8789
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5419961-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical