Provider Demographics
NPI:1770690083
Name:NEWMAN, CAROL RUTH (LP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:RUTH
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 VILLAGE CENTER DR # 359
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55127-3016
Mailing Address - Country:US
Mailing Address - Phone:218-429-5282
Mailing Address - Fax:
Practice Address - Street 1:855 MARTHA LAKE COURT
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126
Practice Address - Country:US
Practice Address - Phone:218-429-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3321103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6256700OtherUNITED BEHAVIORAL HEALTH
MN287T4NEOtherBCBS OF MN PROVIDER
MN87766OtherHEALTH PARTNERS
MN277517400Medicaid
MN98556OtherMAYO (MMSI)
MN118235OtherUCARE
MN287T5NEOtherBCBS OF MN INDIVIDUAL