MEDICARE: MS. NICOLE MARIE NOVAK LMSW, CAADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6801091604	MI

General Provider Information

NPI Number	:	1528299658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE MARIE NOVAK LMSW, CAADC

Provider Business Mailing Address
First Line	:	1345 MONROE AVE NW STE 323
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4674
Country	:	US
Telephone Number	:	616-648-4407
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 MONROE AVE NW STE 323
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4674
Country	:	US
Telephone Number	:	616-648-4407
Fax Number	:	616-608-4657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	04/23/2025

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