Provider Demographics
NPI:1174794382
Name:NOVICK, KERRY KELLY
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:KELLY
Last Name:NOVICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2745
Mailing Address - Country:US
Mailing Address - Phone:734-665-6745
Mailing Address - Fax:734-665-2875
Practice Address - Street 1:617 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2745
Practice Address - Country:US
Practice Address - Phone:734-665-6745
Practice Address - Fax:734-665-2875
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst