Provider Demographics
NPI:1689749608
Name:NOVI, AMY BETHPRANA (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETHPRANA
Last Name:NOVI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:DANIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2306 NE GLISAN ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-310-6795
Mailing Address - Fax:503-954-3332
Practice Address - Street 1:2306 NE GLISAN ST.
Practice Address - Street 2:SUTIE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-310-6795
Practice Address - Fax:503-954-3332
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORL6816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health