Provider Demographics
NPI:1649791757
Name:NEWMAN, MICHELLE GAYLE (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:GAYLE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MOORE BUILDING
Mailing Address - Street 2:THE PENNSYLVANIA STATE UNIVERSITY
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802-3103
Mailing Address - Country:US
Mailing Address - Phone:814-863-1148
Mailing Address - Fax:
Practice Address - Street 1:314 MOORE BLDG
Practice Address - Street 2:THE PENNSYLVANIA STATE UNIVERSITY
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-3103
Practice Address - Country:US
Practice Address - Phone:814-863-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-008386-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist