Healthcare Provider Details

I. General information

NPI: 1649961574
Provider Name (Legal Business Name): NOVELLE A. COURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OAK ST STE 21
PATCHOGUE NY
11772-2841
US

IV. Provider business mailing address

14 GLEN HOLLOW DR APT E29
HOLTSVILLE NY
11742-2439
US

V. Phone/Fax

Practice location:
  • Phone: 516-652-8359
  • Fax:
Mailing address:
  • Phone: 516-652-8359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: