Provider Demographics
NPI:1548072788
Name:NOVAK, EMILY KATHRYN (PCSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHRYN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-0957
Mailing Address - Country:US
Mailing Address - Phone:917-254-2822
Mailing Address - Fax:
Practice Address - Street 1:125 E PEARL AVE
Practice Address - Street 2:SUITE 108 PO BOX 2019
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-690-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-12101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical