Provider Demographics
NPI:1164609459
Name:PALEES, OLGA (05/31/1984)
Entity Type:Individual
Prefix:MS
First Name:OLGA
Middle Name:
Last Name:PALEES
Suffix:
Gender:F
Credentials:05/31/1984
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 SURF AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1406
Mailing Address - Country:US
Mailing Address - Phone:718-372-3300
Mailing Address - Fax:718-996-8758
Practice Address - Street 1:3312 SURF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1406
Practice Address - Country:US
Practice Address - Phone:718-372-3300
Practice Address - Fax:718-996-8758
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00057385Medicaid
NYNOL591Medicare PIN