Provider Demographics
NPI:1992491302
Name:NEWBERRY, BRENIN (CBT)
Entity type:Individual
Prefix:
First Name:BRENIN
Middle Name:
Last Name:NEWBERRY
Suffix:
Gender:M
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 LAKE WHATCOM BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-5206
Mailing Address - Country:US
Mailing Address - Phone:360-746-4092
Mailing Address - Fax:877-205-5722
Practice Address - Street 1:5711 VISTA DR STE 100
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8333
Practice Address - Country:US
Practice Address - Phone:360-746-4092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61399170103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst