Provider Demographics
NPI:1013996040
Name:NOVI, MARY JANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY JANE
Middle Name:
Last Name:NOVI
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 1:13307 W PAINTBRUSH DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-2531
Mailing Address - Country:US
Mailing Address - Phone:215-287-2116
Mailing Address - Fax:
Practice Address - Street 1:13307 W PAINTBRUSH DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375
Practice Address - Country:US
Practice Address - Phone:215-287-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006016L103TC0700X
AZ3850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA413429OtherBLUE SHIELD
PA413429OtherBLUE SHIELD
PA413429Medicare ID - Type UnspecifiedMEDICARE