Provider Demographics
NPI:1295453595
Name:NEWMAN, EMILY NELSON (PSYD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NELSON
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5106
Mailing Address - Country:US
Mailing Address - Phone:312-825-9822
Mailing Address - Fax:
Practice Address - Street 1:4164 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3083
Practice Address - Country:US
Practice Address - Phone:312-825-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.011207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical