Provider Demographics
NPI:1902430465
Name:NEWMAN, TAYLOR (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:MORELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 S PATERSON ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4534
Mailing Address - Country:US
Mailing Address - Phone:608-571-0558
Mailing Address - Fax:608-807-5675
Practice Address - Street 1:303 S PATERSON ST STE 1A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4534
Practice Address - Country:US
Practice Address - Phone:608-571-0558
Practice Address - Fax:608-807-5675
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI916-58103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI916-58OtherTHE STATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES