Provider Demographics
NPI:1841623832
Name:NOVICK, JOHN T (CASAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:NOVICK
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 0177, 1062 STE. RTE. 38
Mailing Address - Street 2:TOIGA COUNTY MENTAL HYGIENE
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-0177
Mailing Address - Country:US
Mailing Address - Phone:607-687-4000
Mailing Address - Fax:
Practice Address - Street 1:1062 STE. RTE. 38
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13872-0177
Practice Address - Country:US
Practice Address - Phone:607-687-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18238101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)