Provider Demographics
NPI:1801057013
Name:NEWELT, KENNETH EDWARD (MA, MFT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EDWARD
Last Name:NEWELT
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 RIVERSIDE DR
Mailing Address - Street 2:SUITE 318
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2500
Mailing Address - Country:US
Mailing Address - Phone:818-242-0600
Mailing Address - Fax:
Practice Address - Street 1:13400 RIVERSIDE DR
Practice Address - Street 2:SUITE 318
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2500
Practice Address - Country:US
Practice Address - Phone:818-242-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist