Provider Demographics
NPI:1649439811
Name:NEWBURY, BRIAN (LCMHC, LCPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:NEWBURY
Suffix:
Gender:M
Credentials:LCMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WAYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1231
Mailing Address - Country:US
Mailing Address - Phone:207-647-4404
Mailing Address - Fax:207-647-4170
Practice Address - Street 1:15 WAYSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1231
Practice Address - Country:US
Practice Address - Phone:207-647-4404
Practice Address - Fax:207-647-4170
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3601101YP2500X
NH822101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health