Provider Demographics
NPI:1891442000
Name:NEWMAN, MARIE GRACE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:GRACE
Last Name:NEWMAN
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 1:1026 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KULPMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17834-1210
Mailing Address - Country:US
Mailing Address - Phone:814-691-7574
Mailing Address - Fax:
Practice Address - Street 1:1026 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:KULPMONT
Practice Address - State:PA
Practice Address - Zip Code:17834-1210
Practice Address - Country:US
Practice Address - Phone:814-691-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician