Healthcare Provider Details

I. General information

NPI: 1598441693
Provider Name (Legal Business Name): DANIELLE NOVICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WISCONSIN AVE NW
WASHINGTON DC
20007-2265
US

IV. Provider business mailing address

350 GEORGE ST
NEW HAVEN CT
06511-6617
US

V. Phone/Fax

Practice location:
  • Phone: 202-944-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY200001636
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: