Provider Demographics
NPI:1275665606
Name:NOVELL, DENISE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MARIE
Last Name:NOVELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 W. SHAW AVENUE #108
Mailing Address - Street 2:FRESNO
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3400
Mailing Address - Country:US
Mailing Address - Phone:559-903-2409
Mailing Address - Fax:559-436-1767
Practice Address - Street 1:2377 W. SHAW AVENUE #108
Practice Address - Street 2:FRESNO
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3400
Practice Address - Country:US
Practice Address - Phone:559-903-2409
Practice Address - Fax:559-436-1767
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13009103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical