Provider Demographics
NPI:1336250083
Name:NOVEMBER, JAMES (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:NOVEMBER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-5325
Mailing Address - Country:US
Mailing Address - Phone:904-256-7231
Mailing Address - Fax:630-604-2468
Practice Address - Street 1:4400 MARSH LANDING BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1287
Practice Address - Country:US
Practice Address - Phone:904-256-7231
Practice Address - Fax:630-604-2468
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2480103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR59861Medicare UPIN
FL73757BMedicare ID - Type Unspecified