Provider Demographics
NPI:1215092911
Name:STUART NOVICK PH.D.,P.A.
Entity type:Organization
Organization Name:STUART NOVICK PH.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-960-0403
Mailing Address - Street 1:14021 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2401
Mailing Address - Country:US
Mailing Address - Phone:813-960-0403
Mailing Address - Fax:813-960-4790
Practice Address - Street 1:14021 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2401
Practice Address - Country:US
Practice Address - Phone:813-960-0403
Practice Address - Fax:813-960-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-25
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty