Provider Demographics
NPI:1164754537
Name:NOVOTNY, KEVIN (PSYD ;MBA)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:NOVOTNY
Suffix:
Gender:M
Credentials:PSYD ;MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W CAMINO REAL
Mailing Address - Street 2:SUITE 123
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-901-3660
Mailing Address - Fax:
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 123
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-901-3660
Practice Address - Fax:561-391-5054
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health