Provider Demographics
NPI:1104032192
Name:NOVICK, ELEANOR A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:A
Last Name:NOVICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 BROOKTREE RD
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3901
Mailing Address - Country:US
Mailing Address - Phone:310-476-9572
Mailing Address - Fax:310-459-2860
Practice Address - Street 1:100 S WESTGATE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4223
Practice Address - Country:US
Practice Address - Phone:310-476-9572
Practice Address - Fax:310-459-2860
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT8676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist