Provider Demographics
NPI:1144604950
Name:OLITZKY PEDIATRIC PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:OLITZKY PEDIATRIC PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LITTMAN
Authorized Official - Last Name:OLITZKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP, NCSP
Authorized Official - Phone:917-575-7985
Mailing Address - Street 1:2516 QUENTIN CT
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1900
Mailing Address - Country:US
Mailing Address - Phone:917-575-7985
Mailing Address - Fax:
Practice Address - Street 1:4700 PARK GLEN RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5701
Practice Address - Country:US
Practice Address - Phone:917-575-7985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5511103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty