Provider Demographics
NPI:1407203474
Name:NOVOA, ELIZABETH (LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NOVOA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-4321
Mailing Address - Country:US
Mailing Address - Phone:845-224-1360
Mailing Address - Fax:
Practice Address - Street 1:2 NORTH DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-4321
Practice Address - Country:US
Practice Address - Phone:845-224-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094583-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker