Provider Demographics
NPI:1801852991
Name:NEWELL, LARISA E (PHD)
Entity type:Individual
Prefix:DR
First Name:LARISA
Middle Name:E
Last Name:NEWELL
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 1:7047 E GREENWAY PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-8107
Mailing Address - Country:US
Mailing Address - Phone:602-478-1477
Mailing Address - Fax:602-773-0998
Practice Address - Street 1:7047 E GREENWAY PKWY STE 250
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-8113
Practice Address - Country:US
Practice Address - Phone:602-478-1477
Practice Address - Fax:602-773-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ82862Medicare ID - Type Unspecified
AZS22896Medicare UPIN