Provider Demographics
NPI:1659403608
Name:NOVAK, BRANDY E (MS LMFT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:E
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HARDING BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2470
Mailing Address - Country:US
Mailing Address - Phone:916-532-5330
Mailing Address - Fax:
Practice Address - Street 1:300 HARDING BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2470
Practice Address - Country:US
Practice Address - Phone:916-532-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC#52813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist