Provider Demographics
NPI:1215044136
Name:OLSEN, VIVIAN F (EDD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:F
Last Name:OLSEN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PINE HILL RD
Mailing Address - Street 2:DEMAREST
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1309
Mailing Address - Country:US
Mailing Address - Phone:201-767-1736
Mailing Address - Fax:
Practice Address - Street 1:14 PINE HILL RD
Practice Address - Street 2:DEMAREST
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-1309
Practice Address - Country:US
Practice Address - Phone:201-767-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI02818103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist