Provider Demographics
NPI:1073692091
Name:NOVAK, DON FRANCIS (MA)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:FRANCIS
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18375 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1072
Mailing Address - Country:US
Mailing Address - Phone:734-676-8846
Mailing Address - Fax:734-676-8789
Practice Address - Street 1:2514 BIDDLE AV
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-7891
Practice Address - Country:US
Practice Address - Phone:734-281-7030
Practice Address - Fax:734-676-8789
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006457101YM0800X
MI6301001600103TC0700X
MI68010019521041C0700X
MI4101000389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP1 0890178OtherBLUE CROSS OF MI