1336632926 NPI number — JOHN HAYES NEWBERRY MSSW, MA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336632926 NPI number — JOHN HAYES NEWBERRY MSSW, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWBERRY
Provider First Name:
JOHN
Provider Middle Name:
HAYES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSSW, MA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEWBERRY
Provider Other First Name:
JAY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1336632926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1563 MISSION ST FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94103-2592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-213-1700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1563 MISSION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94103-2543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-213-1700
Provider Business Practice Location Address Fax Number:
415-865-0119
Provider Enumeration Date:
06/08/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  7140 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: AMFT117035 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 390200000X , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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