Provider Demographics
NPI: | 1497938393 |
---|---|
Name: | NOVOA, DANILO JOSE (LCSW) |
Entity Type: | Individual |
Prefix: | |
First Name: | DANILO |
Middle Name: | JOSE |
Last Name: | NOVOA |
Suffix: | |
Gender: | M |
Credentials: | LCSW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 415 E 27TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77008-2203 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-992-5010 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4617 MONTROSE BLVD |
Practice Address - Street 2: | SUITE C206 |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77006-6101 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-992-5010 |
Practice Address - Fax: | 888-480-8948 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-12-13 |
Last Update Date: | 2012-07-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 9717 | 101YA0400X |
TX | 38953 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | TXB111128 | Other | TRAILBLAZER ENTERPRISES (MEDICARE/CMS) |