Provider Demographics
NPI:1235295809
Name:OLIVER, MIRIAM NELSON (MSW, LICSW, LMT)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:NELSON
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MSW, LICSW, LMT
Other - Prefix:MS
Other - First Name:MIRIAM
Other - Middle Name:NELSON
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW, LMT
Mailing Address - Street 1:300 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3675
Mailing Address - Country:US
Mailing Address - Phone:781-504-3838
Mailing Address - Fax:781-485-6119
Practice Address - Street 1:300 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3675
Practice Address - Country:US
Practice Address - Phone:781-504-3838
Practice Address - Fax:781-485-6119
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW786461041C0700X
MALICSW1050941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOLP20763Medicare ID - Type Unspecified
MA1851519Medicaid
MAP05682OtherBLUE CROSS BLUE SHIELD
MAOLP20763Medicare ID - Type Unspecified