Provider Demographics
NPI:1457412579
Name:NEWBERG, PHILIP F (PH D)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:F
Last Name:NEWBERG
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:DR
Other - First Name:PHILIP
Other - Middle Name:F
Other - Last Name:NEWBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:17150 NEWHOPE ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4250
Mailing Address - Country:US
Mailing Address - Phone:714-437-7400
Mailing Address - Fax:714-437-7410
Practice Address - Street 1:16560 HARBOR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1336
Practice Address - Country:US
Practice Address - Phone:714-437-7400
Practice Address - Fax:714-437-7410
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4593103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC1861OtherMARRIAGE AND FAMILY THERA
CAPSY4593Medicare ID - Type UnspecifiedMEDICARE