Provider Demographics
NPI:1609199736
Name:NOVIS, JENNIFER MAELISA (MA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MAELISA
Last Name:NOVIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N ALTADENA DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3386
Mailing Address - Country:US
Mailing Address - Phone:626-792-2812
Mailing Address - Fax:
Practice Address - Street 1:40 N ALTADENA DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3386
Practice Address - Country:US
Practice Address - Phone:626-792-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF87068106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAICAN900OtherLA COUNTY DMH