Provider Demographics
NPI:1821198359
Name:NOVAK, ANNA (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23425 COMMERCE PARK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5848
Mailing Address - Country:US
Mailing Address - Phone:216-831-2900
Mailing Address - Fax:216-831-4306
Practice Address - Street 1:23425 COMMERCE PARK
Practice Address - Street 2:SUITE 104
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5848
Practice Address - Country:US
Practice Address - Phone:216-831-2900
Practice Address - Fax:216-831-4306
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00095981041C0700X
OHI.00095981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000337047OtherANTHEM BC & BS
OH725592000OtherMAGELLAN
OHSW27601Medicare ID - Type Unspecified
OHQ10974Medicare UPIN