Healthcare Provider Details

I. General information

NPI: 1922919430
Provider Name (Legal Business Name): JAY EDWARD NOVICKI BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 N DYSART RD
SURPRISE AZ
85379-3308
US

IV. Provider business mailing address

16991 W HOPE DR
SURPRISE AZ
85388-6127
US

V. Phone/Fax

Practice location:
  • Phone: 602-887-8268
  • Fax:
Mailing address:
  • Phone: 602-887-8268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: