Provider Demographics
NPI:1184033409
Name:OLIVER, PHYLLISTINE ANNETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLISTINE
Middle Name:ANNETTE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 EDUCATION DR
Mailing Address - Street 2:BEACON CITY SCHOOL DISTRICT
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-4067
Mailing Address - Country:US
Mailing Address - Phone:845-838-6900
Mailing Address - Fax:845-838-6978
Practice Address - Street 1:29 EDUCATION DR
Practice Address - Street 2:BEACON CITY SCHOOL DISTRICT
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-4067
Practice Address - Country:US
Practice Address - Phone:845-838-6900
Practice Address - Fax:845-838-6978
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080303-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical