Provider Demographics
NPI:1376024273
Name:OTOLINSKY, NICOLE (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:OTOLINSKY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:325 INDUSTRIAL PARK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4133
Mailing Address - Country:US
Mailing Address - Phone:814-419-8046
Mailing Address - Fax:
Practice Address - Street 1:325 INDUSTRIAL PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4133
Practice Address - Country:US
Practice Address - Phone:814-419-8046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2023-11-09
Deactivation Date:2019-08-02
Deactivation Code:
Reactivation Date:2019-08-26
Provider Licenses
StateLicense IDTaxonomies
PAPC014234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional