Provider Demographics
NPI:1326196551
Name:NOVER, MICHAEL LEONARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEONARD
Last Name:NOVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 FRANKLIN CORNER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2531
Mailing Address - Country:US
Mailing Address - Phone:732-431-3000
Mailing Address - Fax:609-406-9319
Practice Address - Street 1:75 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2114
Practice Address - Country:US
Practice Address - Phone:732-431-3000
Practice Address - Fax:732-431-3037
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100275100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ648445Medicare ID - Type Unspecified