Provider Demographics
NPI:1336632926
Name:NEWBERRY, JOHN HAYES (MSSW, MA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HAYES
Last Name:NEWBERRY
Suffix:
Gender:M
Credentials:MSSW, MA
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:NEWBERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSW, MA
Mailing Address - Street 1:1930 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6228
Mailing Address - Country:US
Mailing Address - Phone:415-502-7579
Mailing Address - Fax:415-502-4768
Practice Address - Street 1:1930 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6228
Practice Address - Country:US
Practice Address - Phone:415-502-7579
Practice Address - Fax:415-502-4768
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17026101YP2500X
CAAMFT117035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000XMedicaid