Healthcare Provider Details

I. General information

NPI: 1699614974
Provider Name (Legal Business Name): NOVA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 FOUNTAIN TER
NEW HAVEN CT
06515-1808
US

IV. Provider business mailing address

120 FOUNTAIN TER
NEW HAVEN CT
06515-1808
US

V. Phone/Fax

Practice location:
  • Phone: 203-808-2807
  • Fax:
Mailing address:
  • Phone: 203-808-2807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL OGLESBY
Title or Position: BEHAVIOR ANALYST
Credential: BCBA/LBA
Phone: 203-808-2807