Provider Demographics
NPI:1942822143
Name:NOVAK, ANNA ADELE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ADELE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7824 BIRMINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5406
Mailing Address - Country:US
Mailing Address - Phone:443-622-9373
Mailing Address - Fax:
Practice Address - Street 1:7824 BIRMINGHAM AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-5406
Practice Address - Country:US
Practice Address - Phone:443-622-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician