Provider Demographics
NPI:1295383305
Name:OLSSON, ERIC-PAUL ERNEST (CNP, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ERIC-PAUL
Middle Name:ERNEST
Last Name:OLSSON
Suffix:
Gender:M
Credentials:CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 GROVE ST STE 2400
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2273
Mailing Address - Country:US
Mailing Address - Phone:774-290-4175
Mailing Address - Fax:
Practice Address - Street 1:275 GROVE ST STE 2-400
Practice Address - Street 2:#4031
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2273
Practice Address - Country:US
Practice Address - Phone:774-290-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-01
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2278858163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health