Provider Demographics
NPI:1245607944
Name:OLSEN, CLAIRE (LCSW)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:OLSEN
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 1:12 COLMAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2711
Mailing Address - Country:US
Mailing Address - Phone:631-467-8788
Mailing Address - Fax:631-467-8843
Practice Address - Street 1:12 COLMAR AVE
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2711
Practice Address - Country:US
Practice Address - Phone:631-467-8788
Practice Address - Fax:631-467-8843
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1890101YA0400X
NY0692971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)