Provider Demographics
NPI:1700645280
Name:BERNSTEIN-NEWTON, JESSICA A (LMT, BCTMB)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BERNSTEIN-NEWTON
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:NEW FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:17349-9576
Mailing Address - Country:US
Mailing Address - Phone:410-493-0196
Mailing Address - Fax:
Practice Address - Street 1:2360 W JOPPA RD STE 315
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4639
Practice Address - Country:US
Practice Address - Phone:410-205-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM03097225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist