Provider Demographics
NPI:1417366238
Name:OLSEN, CINDY JO (MS)
Entity Type:Individual
Prefix:
First Name:CINDY JO
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LONGMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2215
Mailing Address - Country:US
Mailing Address - Phone:203-233-0568
Mailing Address - Fax:
Practice Address - Street 1:11 LONGMEADOW DR
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2215
Practice Address - Country:US
Practice Address - Phone:203-233-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional