Provider Demographics
NPI:1295830248
Name:OLIVERE, MARK ROY (LMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ROY
Last Name:OLIVERE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 SOUTHGATE CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5514
Mailing Address - Country:US
Mailing Address - Phone:941-400-7702
Mailing Address - Fax:941-388-7930
Practice Address - Street 1:3205 SOUTHGATE CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5514
Practice Address - Country:US
Practice Address - Phone:941-400-7702
Practice Address - Fax:941-388-7930
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766008100Medicaid