Provider Demographics
NPI:1093904443
Name:NOVAK, MARY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N OTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-4006
Mailing Address - Country:US
Mailing Address - Phone:800-240-7011
Mailing Address - Fax:815-730-4918
Practice Address - Street 1:26 W SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2229
Practice Address - Country:US
Practice Address - Phone:630-495-8008
Practice Address - Fax:630-495-9854
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional