Provider Demographics
NPI:1477809366
Name:OLSEN, MARIE L
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:OLSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:NORTH HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05665-0003
Mailing Address - Country:US
Mailing Address - Phone:802-917-3183
Mailing Address - Fax:
Practice Address - Street 1:200 PARK ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-9098
Practice Address - Country:US
Practice Address - Phone:802-917-3183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0063061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health