Provider Demographics
NPI:1275765257
Name:OLIVER, NEVILLE H JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NEVILLE
Middle Name:H
Last Name:OLIVER
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S COTTAGE ST
Mailing Address - Street 2:APT 204
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6361
Mailing Address - Country:US
Mailing Address - Phone:516-428-4272
Mailing Address - Fax:516-825-1270
Practice Address - Street 1:7158 AUSTIN ST
Practice Address - Street 2:SUITE#101
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4732
Practice Address - Country:US
Practice Address - Phone:718-557-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078782104100000X
NY0833601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
474908712OtherTAX IDENTIFICATION NUMBER