Provider Demographics
NPI:1659494839
Name:NOVITSKY, DIONE RABAGO (LCSW, LMSW)
Entity Type:Individual
Prefix:
First Name:DIONE
Middle Name:RABAGO
Last Name:NOVITSKY
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 GREAT OAKS BLVD (180D/SJC)
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119
Mailing Address - Country:US
Mailing Address - Phone:408-363-3000
Mailing Address - Fax:
Practice Address - Street 1:80 GREAT OAKS BLVD (180D/SJC)
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119
Practice Address - Country:US
Practice Address - Phone:408-363-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-08-02
Deactivation Date:2009-09-10
Deactivation Code:
Reactivation Date:2012-07-11
Provider Licenses
StateLicense IDTaxonomies
NY074729-11041C0700X
CA720461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical