=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942895743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLY BROOKE NOVOSELSKY LCPC, CADC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2021
-----------------------------------------------------
Last Update Date | 11/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 N OAK PARK AVE STE 2B
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60301-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-494-9898
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 N OAK PARK AVE STE 2B
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60301-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-494-9898
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 178.016537
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------