Provider Demographics
NPI:1215215975
Name:NOVET, VLAD (LCSW,CASAC)
Entity Type:Individual
Prefix:
First Name:VLAD
Middle Name:
Last Name:NOVET
Suffix:
Gender:M
Credentials:LCSW,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 SHORE FRONT PKWY
Mailing Address - Street 2:APT.# 3M
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1258
Mailing Address - Country:US
Mailing Address - Phone:917-873-3769
Mailing Address - Fax:
Practice Address - Street 1:7600 SHORE FRONT PKWY
Practice Address - Street 2:APT.# 3M
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1258
Practice Address - Country:US
Practice Address - Phone:917-873-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078493101YA0400X, 101YM0800X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY078493Medicaid