Provider Demographics
NPI:1306978168
Name:NOVACK, GAY R (LCSW)
Entity type:Individual
Prefix:
First Name:GAY
Middle Name:R
Last Name:NOVACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 FIR PL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4708
Mailing Address - Country:US
Mailing Address - Phone:516-678-3048
Mailing Address - Fax:516-594-9592
Practice Address - Street 1:540 FIR PL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4708
Practice Address - Country:US
Practice Address - Phone:516-678-3048
Practice Address - Fax:516-594-9592
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR021424-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02034182Medicaid
NY02034182Medicaid