Provider Demographics
NPI:1316529415
Name:NOVA BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:NOVA BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NADYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIFEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:174-026-2377
Mailing Address - Street 1:221 QUEEN ESTHER DR
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-9698
Mailing Address - Country:US
Mailing Address - Phone:740-262-3777
Mailing Address - Fax:570-888-2641
Practice Address - Street 1:703 S ELMER AVE STE 107
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2400
Practice Address - Country:US
Practice Address - Phone:570-203-1735
Practice Address - Fax:570-888-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty