Provider Demographics
NPI:1215056080
Name:NEWBERRY GROUP, INC.
Entity type:Organization
Organization Name:NEWBERRY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRAAKSMA
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D
Authorized Official - Phone:262-338-1900
Mailing Address - Street 1:125 S MAIN ST
Mailing Address - Street 2:STE. B
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3361
Mailing Address - Country:US
Mailing Address - Phone:262-338-1900
Mailing Address - Fax:262-338-1837
Practice Address - Street 1:125 S MAIN ST
Practice Address - Street 2:STE. B
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3361
Practice Address - Country:US
Practice Address - Phone:262-338-1900
Practice Address - Fax:262-338-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1236 057251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health