Provider Demographics
NPI:1568577666
Name:NOVOTNY, DANIEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:NOVOTNY
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 1:1811 W 2ND STREET
Mailing Address - Street 2:SUITE 435
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5413
Mailing Address - Country:US
Mailing Address - Phone:308-384-3138
Mailing Address - Fax:308-381-0658
Practice Address - Street 1:1811 W 2ND STREET
Practice Address - Street 2:SUITE 435
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5413
Practice Address - Country:US
Practice Address - Phone:308-384-3138
Practice Address - Fax:308-381-0658
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE737861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE265854N0Medicare ID - Type Unspecified
R96860Medicare UPIN