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NPI Code Detail

MEDICARE: MS. LYLA MARIE NOVAK M.ED., L.M.H.C.

MEDICARE: MS. LYLA MARIE NOVAK M.ED., L.M.H.C.
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
1101YM0800XMental Health Counselor5300MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15300OTHERMAL.M.H.C.

General Provider Information

NPI Number : 1912053703
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LYLA MARIE NOVAK M.ED., L.M.H.C.
Provider Business Mailing Address
First Line : 2322 MAIN STREET
Second Line :
City : WEST WARREN
State : MA
Zip : 01092-0588
Country : US
Telephone Number : 413-436-7647
Fax Number :
Provider Business Practice Location Address
First Line : 96 SOUTH ST
Second Line :
City : WARE
State : MA
Zip : 01082-1616
Country : US
Telephone Number : 413-967-6241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 03/09/2018

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