Provider Demographics
NPI:1912152661
Name:NEWBERRY, KRISTEN M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:M
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 BLOOMINGDALE RD STE B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2151
Mailing Address - Country:US
Mailing Address - Phone:630-383-7222
Mailing Address - Fax:
Practice Address - Street 1:2005 BLOOMINGDALE RD STE B
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-2151
Practice Address - Country:US
Practice Address - Phone:630-383-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071.008644OtherCLINICAL PSYCHOLOGIST, LICENSE