Provider Demographics
NPI:1225490584
Name:OLIVER LCSW PLLC
Entity Type:Organization
Organization Name:OLIVER LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLWYN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-623-7778
Mailing Address - Street 1:557 W 148TH ST
Mailing Address - Street 2:STE 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-3704
Mailing Address - Country:US
Mailing Address - Phone:917-623-7778
Mailing Address - Fax:
Practice Address - Street 1:557 W 148TH ST
Practice Address - Street 2:STE 3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-3704
Practice Address - Country:US
Practice Address - Phone:917-623-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0811651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty