Provider Demographics
NPI:1659858389
Name:NEWSOME, RYAN SCOTT (LISW-S)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:SCOTT
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 DORAL AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2528
Mailing Address - Country:US
Mailing Address - Phone:614-800-9487
Mailing Address - Fax:
Practice Address - Street 1:464 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5448
Practice Address - Country:US
Practice Address - Phone:614-614-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2203884-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical