Provider Demographics
NPI:1871798181
Name:NOVELLO, PAUL (LCSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:NOVELLO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 217TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3567
Mailing Address - Country:US
Mailing Address - Phone:718-225-2599
Mailing Address - Fax:718-225-2599
Practice Address - Street 1:352 7TH AVE
Practice Address - Street 2:1215
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5012
Practice Address - Country:US
Practice Address - Phone:917-705-8533
Practice Address - Fax:917-705-8533
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057128-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical