Provider Demographics
NPI:1912053703
Name:NOVAK, LYLA MARIE (MED, LMHC)
Entity Type:Individual
Prefix:MS
First Name:LYLA
Middle Name:MARIE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WEST WARREN
Mailing Address - State:MA
Mailing Address - Zip Code:01092-0588
Mailing Address - Country:US
Mailing Address - Phone:413-436-7647
Mailing Address - Fax:
Practice Address - Street 1:96 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1616
Practice Address - Country:US
Practice Address - Phone:413-967-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5300OtherL.M.H.C.