Provider Demographics
NPI:1093084162
Name:NOVAK, SUSAN JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOY
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:JOY
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:23832 ROCKFIELD BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2860
Mailing Address - Country:US
Mailing Address - Phone:949-297-6680
Mailing Address - Fax:949-830-5530
Practice Address - Street 1:23832 ROCKFIELD BLVD
Practice Address - Street 2:STE 130
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2860
Practice Address - Country:US
Practice Address - Phone:949-297-6680
Practice Address - Fax:949-861-6321
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22415103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical