Individual
MALLISSA NEWTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2081 SW KASIM TER, PORT SAINT LUCIE, FL 34953-2163
(772) 333-0728
Mailing address
2081 SW KASIM TER, PORT SAINT LUCIE, FL 34953-2163
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
11/13/2017
Last updated
12/17/2018
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