Provider Demographics
NPI:1073636619
Name:OLIVIA PINSLEY
Entity Type:Organization
Organization Name:OLIVIA PINSLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW-R
Authorized Official - Phone:516-642-1174
Mailing Address - Street 1:445 NORTHERN BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4804
Mailing Address - Country:US
Mailing Address - Phone:516-642-1174
Mailing Address - Fax:516-467-4267
Practice Address - Street 1:445 NORTHERN BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4804
Practice Address - Country:US
Practice Address - Phone:516-642-1174
Practice Address - Fax:516-467-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041584-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty