Provider Demographics
NPI:1164244208
Name:NOVAK, ALLISON BROOKE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:BROOKE
Last Name:NOVAK
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 1:13582 PURDY ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2522
Mailing Address - Country:US
Mailing Address - Phone:909-921-4959
Mailing Address - Fax:
Practice Address - Street 1:17752 SKY PARK CIR STE 140
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4469
Practice Address - Country:US
Practice Address - Phone:949-474-5577
Practice Address - Fax:949-475-5575
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician