Provider Demographics
NPI:1669684627
Name:NEWQUIST, GARY DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DAVID
Last Name:NEWQUIST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91319-0803
Mailing Address - Country:US
Mailing Address - Phone:805-603-3282
Mailing Address - Fax:
Practice Address - Street 1:5923 KANAN RD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1688
Practice Address - Country:US
Practice Address - Phone:805-603-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17973106H00000X
CAPSY10987103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist