MEDICARE: VIRGINIA NOVAK LCSW

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	101Y00000X	Counselor	LCSW 9906	AZ

General Provider Information

NPI Number	:	1659594208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA NOVAK LCSW

Provider Business Mailing Address
First Line	:	1705 S JONES BLVD APT F12
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-7102
Country	:	US
Telephone Number	:	520-318-0260
Fax Number	:	520-318-0260

Provider Business Practice Location Address
First Line	:	1705 S JONES BLVD APT F12
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-7102
Country	:	US
Telephone Number	:	520-318-0260
Fax Number	:	520-318-0260

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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Directions to “ VIRGINIA NOVAK LCSW” Practice Location

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