Provider Demographics
NPI:1407884216
Name:OLSON, MARK R (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:OLSON
Suffix:
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 1:56 CHARLONATE DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9764
Mailing Address - Country:US
Mailing Address - Phone:207-657-2203
Mailing Address - Fax:207-657-2013
Practice Address - Street 1:56 CHARLONATE DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9764
Practice Address - Country:US
Practice Address - Phone:207-657-2203
Practice Address - Fax:207-657-2013
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC10181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical