Provider Demographics
NPI:1336632926
Name:NEWBERRY, JOHN HAYES (MSSW, MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HAYES
Last Name:NEWBERRY
Suffix:
Gender:M
Credentials:MSSW, MA
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:NEWBERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSW
Mailing Address - Street 1:1563 MISSION ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2592
Mailing Address - Country:US
Mailing Address - Phone:415-213-1700
Mailing Address - Fax:
Practice Address - Street 1:1563 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2543
Practice Address - Country:US
Practice Address - Phone:415-213-1700
Practice Address - Fax:415-865-0119
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7140101YP2500X
CAAMFT117035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000XMedicaid