Healthcare Provider Details

I. General information

NPI: 1558331249
Provider Name (Legal Business Name): JENNIFER A NOVELLO LMSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 E MOUNT HOPE AVE
LANSING MI
48910-1913
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-999-9005
  • Fax: 517-372-2542
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801069830
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: