Basic Information
| Provider Information | |||||||||
| NPI: | 1295056554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVICK | ||||||||
| FirstName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 SUMNER ST | ||||||||
| Address2: | ADMINISTRATIVE OFFICES | ||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136291251 | ||||||||
| FaxNumber: | 4134482198 | ||||||||
| Practice Location | |||||||||
| Address1: | 38 CHURCH ST | ||||||||
| Address2: | # 102 | ||||||||
| City: | LENOX | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012402525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136291251 | ||||||||
| FaxNumber: | 4134482198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2010 | ||||||||
| LastUpdateDate: | 06/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.