Provider Demographics
NPI:1831641935
Name:NOVAK, ALISA DIANE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:DIANE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:DIANE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 MONT BLANC BLVD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7615
Mailing Address - Country:US
Mailing Address - Phone:302-678-3023
Mailing Address - Fax:302-678-2458
Practice Address - Street 1:103 MONT BLANC BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7615
Practice Address - Country:US
Practice Address - Phone:302-678-3023
Practice Address - Fax:302-678-2458
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL8-00102832084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry