Provider Demographics
NPI:1659858389
Name:NEWSOME, RYAN SCOTT (LSW)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:SCOTT
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 DORAL AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2528
Mailing Address - Country:US
Mailing Address - Phone:330-383-6723
Mailing Address - Fax:
Practice Address - Street 1:37 ROBINWOOD AVE
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-6703
Practice Address - Country:US
Practice Address - Phone:614-338-8733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1600944104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker