Basic Information
| Provider Information | |||||||||
| NPI: | 1699932897 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | V. MARGARET NEWMAN THERAPEUTIC SERVICE, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 215 HIGHLAND AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HADDON TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569522688 | ||||||||
| FaxNumber: | 8564886222 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 HIGHLAND AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HADDON TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569522688 | ||||||||
| FaxNumber: | 8564886222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 07/26/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NEWMAN-FREEMAN | ||||||||
| AuthorizedOfficialFirstName: | VALERIE | ||||||||
| AuthorizedOfficialMiddleName: | MARGARET | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8569522688 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 44SC05240200 | NJ | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 128519Y5J | 01 | MEDICARE PTAN (INDIVIDUAL) | OTHER | 0043192 | 05 | NJ | MEDICAID | 798708 | 01 | NJ | AETNA | OTHER | 807459000 | 01 | NJ | MAGELLAN HEALTH SERVICES | OTHER | 128520 | 01 | MEDICARE PTAN (GROUP) | OTHER | 2623548000 | 01 | PA | BLUE CROSS | OTHER |