Provider Demographics
NPI:1821045113
Name:NOVAK, RACHEL WOODBURY (LICSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:WOODBURY
Last Name:NOVAK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1847
Mailing Address - Country:US
Mailing Address - Phone:508-566-3308
Mailing Address - Fax:781-582-1830
Practice Address - Street 1:111 SOUTH ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1847
Practice Address - Country:US
Practice Address - Phone:508-566-3308
Practice Address - Fax:781-582-1830
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANO-P24000Medicare ID - Type UnspecifiedLICSW