Doctor Name: | MS. KIM NOVAK |
NPI Number: | 1215916473 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 005111 |
Business Practice Address: | 26 Lakeview St East Hampton, CT - 064241200 |
Business Phone Number: | 8603655249 |
Business Fax Number: | 8603655249 |
Mailing Address: | Po Box 298, EAST HAMPTON |
State: | CT |
Postal Code: | 064240298 |
Phone Number: | 8603655249 |
Fax Number: | 8603655249 |
NPI Enumeration Date: | 01/15/2006 |
NPI Last Update Date: | 01/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 005111 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |