Provider Demographics
NPI:1356816607
Name:NOVAK, SANDRA MOXLEY (PSYD, MSW, CHT)
Entity Type:Individual
Prefix:PROF
First Name:SANDRA
Middle Name:MOXLEY
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PSYD, MSW, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MIDDLE RIVER DR STE 103B
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3584
Mailing Address - Country:US
Mailing Address - Phone:800-723-9788
Mailing Address - Fax:800-723-9788
Practice Address - Street 1:915 MIDDLE RIVER DR STE 103B
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3584
Practice Address - Country:US
Practice Address - Phone:800-723-9788
Practice Address - Fax:800-723-9788
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881014405OtherORGANIZATION NPI