Provider Demographics
NPI:1235556499
Name:NEWMAN, BROOKE LEEANNA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:LEEANNA
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 PONDER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3343
Mailing Address - Country:US
Mailing Address - Phone:706-863-9699
Mailing Address - Fax:706-863-9263
Practice Address - Street 1:624 PONDER PLACE DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3343
Practice Address - Country:US
Practice Address - Phone:706-863-9699
Practice Address - Fax:706-863-9263
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-14-15677103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104270400Medicaid