Basic Information
| Provider Information | |||||||||
| NPI: | 1407810021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | L.M.F.T., LADC I | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5700 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049155700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664314077 | ||||||||
| FaxNumber: | 4137747448 | ||||||||
| Practice Location | |||||||||
| Address1: | 238 NORTHAMPTON ST | ||||||||
| Address2: | EASTHAMPTON HEALTH CENTER | ||||||||
| City: | EASTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010271046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135299300 | ||||||||
| FaxNumber: | 4132823880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 09/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 346 | MA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 211 | MA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 33949 | 01 | MA | FALLON | OTHER | 454905 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 24215 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 268952000 | 01 | MA | MAGELLAN BEHAVIORAL HEALT | OTHER | 39354 | 01 | MA | CIGNA BEHAVIORAL HEALTH | OTHER | 5329230 | 01 | MA | AETNA US/HEALTHCARE | OTHER | 331339 | 01 | MA | HARVARD PILGRIM HEALTHCAR | OTHER |