Provider Demographics
NPI:1629103924
Name:ROGER M NEWSTREET LCSW INC
Entity Type:Organization
Organization Name:ROGER M NEWSTREET LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEWSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-415-2678
Mailing Address - Street 1:2600 N MILITARY TRAIL
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-395-3778
Mailing Address - Fax:561-395-5691
Practice Address - Street 1:2600 N MILITARY TRAIL
Practice Address - Street 2:SUITE 215
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-395-3778
Practice Address - Fax:561-395-5691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00039021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z6623AMedicare ID - Type Unspecified