Provider Demographics
NPI:1073520532
Name:NEWMAN, M DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:M
Middle Name:DAWN
Last Name:NEWMAN
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 1:4430 MANNER DALE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3325
Mailing Address - Country:US
Mailing Address - Phone:763-433-8285
Mailing Address - Fax:
Practice Address - Street 1:6655 E U S 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8923
Practice Address - Country:US
Practice Address - Phone:317-272-3330
Practice Address - Fax:317-272-3331
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005086A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000485805OtherANTHEM BCBS PROVIDER PIN
IN344840NNNNMedicare PIN