Individual provider Active NPI

Robert P Newberry

  • Mental Health Counselor
  • Watertown, NY
National Provider Identifier
1457746570
Registry record updated Apr 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
P96672 Issued in NY
Practice address
167 Polk St
Suite 300
Watertown, NY 13601-2770
Phone
(315) 782-7445
Fax
(315) 779-1184
NPI assigned
Apr 6, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X P96672 NY Primary

Addresses

Primary practice location

167 Polk St
Suite 300
Watertown, NY 13601-2770

Mailing address

PO Box 6550
Watertown, NY 13601-6550
Phone (315) 782-7445

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
P96672NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Home of Jefferson County Past Accepting new patients
Children'S Home of Jefferson County PastSince Aug 15, 2016 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428278400000",
    "number": "1457746570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6550",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136016550",
            "telephone_number": "315-782-7445",
            "fax_number": "315-779-1184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 POLK ST",
            "address_2": "SUITE 300",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012770",
            "telephone_number": "315-782-7445",
            "fax_number": "315-779-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEWBERRY",
        "first_name": "ROBERT",
        "middle_name": "P",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-06",
        "last_updated": "2015-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "P96672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.