Provider Demographics
NPI:1205385622
Name:NOVOA, YANETTE
Entity Type:Individual
Prefix:
First Name:YANETTE
Middle Name:
Last Name:NOVOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 SW 14TH ST APT 310C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2476
Mailing Address - Country:US
Mailing Address - Phone:786-346-4182
Mailing Address - Fax:
Practice Address - Street 1:7855 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1826
Practice Address - Country:US
Practice Address - Phone:305-472-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical