Provider Demographics
NPI:1720122146
Name:NEWMAN AVENUE ASSOCIATES, PC
Entity type:Organization
Organization Name:NEWMAN AVENUE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:H
Authorized Official - Last Name:JANTZI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-434-2848
Mailing Address - Street 1:110 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4004
Mailing Address - Country:US
Mailing Address - Phone:540-434-2848
Mailing Address - Fax:540-434-2883
Practice Address - Street 1:110 NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4004
Practice Address - Country:US
Practice Address - Phone:540-434-2848
Practice Address - Fax:540-434-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1074261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05128Medicare PIN