Provider Demographics
NPI:1811388572
Name:NOVO PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:NOVO PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BRODIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:862-377-1042
Mailing Address - Street 1:31 S FULLERTON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3455
Mailing Address - Country:US
Mailing Address - Phone:862-377-1042
Mailing Address - Fax:
Practice Address - Street 1:31 S FULLERTON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3455
Practice Address - Country:US
Practice Address - Phone:862-377-1042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400675973103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty