Provider Demographics
NPI:1134258049
Name:NOVICK-KLINE, PAIGE M
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:M
Last Name:NOVICK-KLINE
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 1:1111 STREET RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4250
Mailing Address - Country:US
Mailing Address - Phone:215-355-2011
Mailing Address - Fax:215-396-1886
Practice Address - Street 1:1111 STREET RD
Practice Address - Street 2:SUITE 312
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4250
Practice Address - Country:US
Practice Address - Phone:215-355-2011
Practice Address - Fax:215-396-1886
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-016096-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist