Provider Demographics
NPI:1720961303
Name:NEWBERRY, CHARISSA ANNE (LMSW)
Entity type:Individual
Prefix:
First Name:CHARISSA
Middle Name:ANNE
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHARISSA
Other - Middle Name:ANNE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15508 W BELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2432
Mailing Address - Country:US
Mailing Address - Phone:480-340-2283
Mailing Address - Fax:
Practice Address - Street 1:15508 W BELL RD STE 101
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2432
Practice Address - Country:US
Practice Address - Phone:480-340-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-22896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health