Provider Demographics
NPI:1184795643
Name:NOVAK, JOSEPH J (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:NOVAK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 EAST GOLF ROAD
Mailing Address - Street 2:#115
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4049
Mailing Address - Country:US
Mailing Address - Phone:847-308-4750
Mailing Address - Fax:847-981-0878
Practice Address - Street 1:415 EAST GOLF ROAD
Practice Address - Street 2:#115
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4049
Practice Address - Country:US
Practice Address - Phone:847-308-4750
Practice Address - Fax:847-981-0878
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL942260Medicare UPIN