Provider Demographics
NPI:1902033871
Name:NOVAK, DONNA TAL (PSYD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:TAL
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 1ST ST STE 210B
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0923
Mailing Address - Country:US
Mailing Address - Phone:805-285-3540
Mailing Address - Fax:
Practice Address - Street 1:2245 1ST ST STE 210B
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0923
Practice Address - Country:US
Practice Address - Phone:805-285-3540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26380103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical