Provider Demographics
NPI:1790010155
Name:NEWBOLD, JEREMIAH JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:JAMES
Last Name:NEWBOLD
Suffix:
Gender:M
Credentials:LCSW
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 671846
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-1846
Mailing Address - Country:US
Mailing Address - Phone:907-229-0917
Mailing Address - Fax:
Practice Address - Street 1:17342 FLINTWOOD PL
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7025
Practice Address - Country:US
Practice Address - Phone:907-696-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCSW S 9191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical