Provider Demographics
NPI:1205595162
Name:NOVICK, JOSH
Entity type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:NOVICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 GREEN BAY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2500
Mailing Address - Country:US
Mailing Address - Phone:847-251-6630
Mailing Address - Fax:
Practice Address - Street 1:825 GREEN BAY RD STE 200
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2500
Practice Address - Country:US
Practice Address - Phone:847-251-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional