Active NPI
Jack Novick, PH.D
- Clinical Psychologist
- Ann Arbor, MI
National Provider Identifier
1710158928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 002202
- Practice address
- 617 Stratford Dr
Ann Arbor, MI 48104-2745 - Phone
- (734) 665-6745
- Fax
- (734) 665-2875
- NPI assigned
- Mar 14, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | 002202 | MI | |
| Adult Development & Aging Psychologist | 103TA0700X | 002202 | MI | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 002202 | MI | |
| Clinical Psychologist | 103TC0700X | 002202 | MI | Primary |
| Counseling Psychologist | 103TC1900X | 002202 | MI | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 002202 | MI | |
| Family Psychologist | 103TF0000X | 002202 | MI |
Addresses
Primary practice location
617 Stratford Dr
Ann Arbor, MI 48104-2745
Mailing address
617 Stratford Dr
Ann Arbor, MI 48104-2745
Phone (734) 665-6745
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0HI45566 | Other | MI | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002202 | MI | MD | Psychoanalyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205452800000",
"number": "1710158928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "617 STRATFORD DR",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481042745",
"telephone_number": "734-665-6745",
"fax_number": "734-665-2875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 STRATFORD DR",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481042745",
"telephone_number": "734-665-6745",
"fax_number": "734-665-2875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOVICK",
"first_name": "JACK",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-14",
"last_updated": "2008-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": "MI",
"license": "002202",
"primary": false
},
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": "MI",
"license": "002202",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MI",
"license": "002202",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "002202",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MI",
"license": "002202",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MI",
"license": "002202",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "MI",
"license": "002202",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "0HI45566",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.