Provider Demographics
NPI:1750512711
Name:NOVELLA, CORINNE AMY (LMSW)
Entity type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:AMY
Last Name:NOVELLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 15TH ST
Mailing Address - Street 2:6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4830
Mailing Address - Country:US
Mailing Address - Phone:718-360-3156
Mailing Address - Fax:
Practice Address - Street 1:900 BROADWAY
Practice Address - Street 2:304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1210
Practice Address - Country:US
Practice Address - Phone:718-779-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0794011041C0700X
NY0802581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical