Provider Demographics
NPI:1063125466
Name:NEWPORT, JADE
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:NEWPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 CERISE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3358
Mailing Address - Country:US
Mailing Address - Phone:504-559-7596
Mailing Address - Fax:
Practice Address - Street 1:4300 S I 10 SERVICE RD W STE 117
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7427
Practice Address - Country:US
Practice Address - Phone:504-841-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17494104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker