Provider Demographics
NPI:1942488051
Name:NEWGREN, JUDITH (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:NEWGREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JOHN MCCAIN RD
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6877
Mailing Address - Country:US
Mailing Address - Phone:817-498-4648
Mailing Address - Fax:
Practice Address - Street 1:200 JOHN MCCAIN RD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6877
Practice Address - Country:US
Practice Address - Phone:817-498-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical