Provider Demographics
NPI:1639952112
Name:KHAN, NOVERA (MHC)
Entity Type:Individual
Prefix:
First Name:NOVERA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 BLOSSOM RD STE 312
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1870
Mailing Address - Country:US
Mailing Address - Phone:158-564-1028
Mailing Address - Fax:
Practice Address - Street 1:595 BLOSSOM RD STE 312
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1870
Practice Address - Country:US
Practice Address - Phone:158-564-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health