Provider Demographics
NPI:1578371845
Name:NEWBERRY SACKS, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:NEWBERRY SACKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 WATERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4015
Mailing Address - Country:US
Mailing Address - Phone:401-633-2929
Mailing Address - Fax:888-602-6957
Practice Address - Street 1:194 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4015
Practice Address - Country:US
Practice Address - Phone:401-633-2929
Practice Address - Fax:888-602-6957
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health