Provider Demographics
NPI:1396786240
Name:NEWBORN, JESSE PAUL (SOCIAL WORKER)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:PAUL
Last Name:NEWBORN
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23602 NORTHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-1603
Mailing Address - Country:US
Mailing Address - Phone:210-497-7584
Mailing Address - Fax:210-497-5463
Practice Address - Street 1:10615 PERRIN BEITEL RD
Practice Address - Street 2:STE 406
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3141
Practice Address - Country:US
Practice Address - Phone:210-572-8327
Practice Address - Fax:210-828-8333
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS061461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147191401Medicaid
TX147191401Medicaid