Provider Demographics
NPI:1144011149
Name:NOVA NEURO NETWORK
Entity type:Organization
Organization Name:NOVA NEURO NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDI-DENISE
Authorized Official - Middle Name:EWURAMA
Authorized Official - Last Name:VANDYCK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:425-591-0654
Mailing Address - Street 1:10530 NE 119TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3902
Mailing Address - Country:US
Mailing Address - Phone:425-591-0654
Mailing Address - Fax:425-242-7485
Practice Address - Street 1:10530 NE 119TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3902
Practice Address - Country:US
Practice Address - Phone:425-591-1063
Practice Address - Fax:425-242-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-16
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty