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NPI Code Detail

MEDICARE: JENNIFER A NOVELLO LMSW, ACSW

MEDICARE: JENNIFER A NOVELLO LMSW, ACSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801069830MI

General Provider Information

NPI Number : 1558331249
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER A NOVELLO LMSW, ACSW
Provider Business Mailing Address
First Line : PO BOX 10
Second Line :
City : MASON
State : MI
Zip : 48854-0010
Country : US
Telephone Number : 517-676-9788
Fax Number : 517-676-3438
Provider Business Practice Location Address
First Line : 2535 E MOUNT HOPE AVE
Second Line :
City : LANSING
State : MI
Zip : 48910-1913
Country : US
Telephone Number : 517-999-9005
Fax Number : 517-372-2542
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 09/11/2012

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