Individual
DR. SANDRA L NOVAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
7219 N LITCHFIELD RD, LUKE AFB, AZ 85309-1529
(623) 859-7579
(623) 856-4433
Mailing address
355TH MDG/OMRS - MENTAL HEALTH CLINIC, 5427 E MADERA ST, BLDG 4339, DAVIS-MONTHAN AFB, AZ 85707
(520) 228-4357
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
071008889
IL
103TC0700X
Clinical Psychologist
Primary
PSY-005303
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400210383
MEDICARE PTAN
IL
Enumeration date
09/16/2006
Last updated
07/05/2023
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