Provider Demographics
NPI:1780663724
Name:NOVAK, DANIEL ELI (PHD, MSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ELI
Last Name:NOVAK
Suffix:
Gender:M
Credentials:PHD, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20687 NOBLE LN
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-7223
Mailing Address - Country:US
Mailing Address - Phone:208-794-0048
Mailing Address - Fax:503-715-4561
Practice Address - Street 1:5 CENTERPOINTE DR STE 400
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8661
Practice Address - Country:US
Practice Address - Phone:503-462-2839
Practice Address - Fax:503-715-4561
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2024-01-07
Deactivation Date:2022-01-14
Deactivation Code:
Reactivation Date:2022-02-03
Provider Licenses
StateLicense IDTaxonomies
ORL128781041C0700X, 1041C0700X
ID405751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical