Provider Demographics
NPI:1487096871
Name:NEWELL, SIDNEY SUSAN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SIDNEY
Middle Name:SUSAN
Last Name:NEWELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SE OAK ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1338
Mailing Address - Country:US
Mailing Address - Phone:503-802-1023
Mailing Address - Fax:503-517-0005
Practice Address - Street 1:901 SE OAK ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1338
Practice Address - Country:US
Practice Address - Phone:503-802-1023
Practice Address - Fax:503-517-0005
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical