Provider Demographics
NPI:1396360566
Name:OLCOTT, GENEVA IVY (LMHC)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:IVY
Last Name:OLCOTT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 POND ST STE 8
Mailing Address - Street 2:PO BOX10
Mailing Address - City:LUDLOW
Mailing Address - State:VT
Mailing Address - Zip Code:05149-9733
Mailing Address - Country:US
Mailing Address - Phone:413-695-8881
Mailing Address - Fax:
Practice Address - Street 1:99 CONIFER HILL DR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1193
Practice Address - Country:US
Practice Address - Phone:413-695-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13303-MH-CC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty