Provider Demographics
NPI:1336982495
Name:NEWSOME, JONATHAN JUSTIN (MSW , LCSW)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JUSTIN
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:MSW , LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 SUNSHINE DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1129
Mailing Address - Country:US
Mailing Address - Phone:415-999-5613
Mailing Address - Fax:
Practice Address - Street 1:293 SUNSHINE DR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1129
Practice Address - Country:US
Practice Address - Phone:415-999-5613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW879731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical