Provider Demographics
NPI:1770004038
Name:NOVA PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:NOVA PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FABIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-936-0309
Mailing Address - Street 1:264 BEACON ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1236
Mailing Address - Country:US
Mailing Address - Phone:617-936-0309
Mailing Address - Fax:617-936-0309
Practice Address - Street 1:264 BEACON ST FL 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1236
Practice Address - Country:US
Practice Address - Phone:617-936-0309
Practice Address - Fax:617-936-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty