Provider Demographics
NPI:1215440193
Name:NEWMAN, KATHYRN (LCDC II)
Entity type:Individual
Prefix:
First Name:KATHYRN
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:LCDC II
Other - Prefix:
Other - First Name:KATHYRN
Other - Middle Name:
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC II
Mailing Address - Street 1:1219 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3717
Mailing Address - Country:US
Mailing Address - Phone:740-285-8809
Mailing Address - Fax:
Practice Address - Street 1:1616 GRANT ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3663
Practice Address - Country:US
Practice Address - Phone:740-529-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140095101YA0400X
OHQMHS101YM0800X
OHLCDC.161472101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health