Provider Demographics
NPI:1679181754
Name:NEWCOMB, JENNIFER ROBIN
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ROBIN
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-1314
Mailing Address - Country:US
Mailing Address - Phone:772-501-7054
Mailing Address - Fax:
Practice Address - Street 1:755 27TH AVE SW STE 9&10
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-4200
Practice Address - Country:US
Practice Address - Phone:772-217-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health