Provider Demographics
NPI:1043824956
Name:MANDRACCHIA, OLIVIA
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:MANDRACCHIA
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 1:43 BRIDGE ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4124
Mailing Address - Country:US
Mailing Address - Phone:781-572-8391
Mailing Address - Fax:
Practice Address - Street 1:43 BRIDGE ST UNIT 2
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4124
Practice Address - Country:US
Practice Address - Phone:781-572-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor