Provider Demographics
NPI:1184285835
Name:NEWTON, LUCILLE ANN
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:ANN
Last Name:NEWTON
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:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:IN
Mailing Address - Zip Code:46111
Mailing Address - Country:US
Mailing Address - Phone:317-910-5118
Mailing Address - Fax:
Practice Address - Street 1:1595 S CALUMET RD STE 3
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2389
Practice Address - Country:US
Practice Address - Phone:219-764-4888
Practice Address - Fax:219-898-4258
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2020-06-17
Deactivation Date:2020-06-09
Deactivation Code:
Reactivation Date:2020-06-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200196020AMedicaid