Provider Demographics
NPI:1932231404
Name:NOVAK, WESLEY GENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:GENE
Last Name:NOVAK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1415 FOULK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2748
Mailing Address - Country:US
Mailing Address - Phone:302-477-0470
Mailing Address - Fax:302-477-1235
Practice Address - Street 1:1415 FOULK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2748
Practice Address - Country:US
Practice Address - Phone:302-477-0470
Practice Address - Fax:302-477-1235
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000295103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical