Provider Demographics
NPI:1043832629
Name:NOVICK, REBECCA BRODKIN (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:BRODKIN
Last Name:NOVICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-1501
Mailing Address - Country:US
Mailing Address - Phone:203-980-9896
Mailing Address - Fax:
Practice Address - Street 1:4441 BIRCH RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-1501
Practice Address - Country:US
Practice Address - Phone:203-980-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223247104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker