Basic Information
Provider Information
NPI: 1760159990
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWBOULD
FirstName: ARTHUR
MiddleName: WILLIAM
NamePrefix: MR.
NameSuffix: IV
Credential: MHC-LP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25 MCGUINNESS BLVD APT 1F
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112224028
CountryCode: US
TelephoneNumber: 4843198252
FaxNumber:  
Practice Location
Address1: 9114 37TH AVE
Address2:  
City: JACKSON HEIGHTS
State: NY
PostalCode: 113727920
CountryCode: US
TelephoneNumber: 7187791600
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/25/2021
LastUpdateDate: 09/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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