MEDICARE: MS. ANN LONG NOVO LCSW

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
1	1041C0700X	Clinical Social Worker	S06407	TX

General Provider Information

NPI Number	:	1760679864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN LONG NOVO LCSW

Provider Business Mailing Address
First Line	:	2412 YORKTOWN ST
Second Line	:	#282
City	:	HOUSTON
State	:	TX
Zip	:	77056-4574
Country	:	US
Telephone Number	:	832-623-6635
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 YORKTOWN ST
Second Line	:	#353
City	:	HOUSTON
State	:	TX
Zip	:	77056-4575
Country	:	US
Telephone Number	:	713-552-0024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	07/01/2015

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