Individual
MR. ANDREAS NOVAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LISW
Contact information
Practice address
3300 N BUTLER AVE, SUITE 204, FARMINGTON, NM 87401-5621
(505) 327-0505
Mailing address
6710 HIGH POINT DR, FARMINGTON, NM 87402-0954
(505) 327-0505
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
983043
CO
1041C0700X
Clinical Social Worker
Primary
I-2364
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00JK65
BLUE CROSS/BLUE SHIELD #
NM
Enumeration date
08/03/2006
Last updated
07/08/2007
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