Provider Demographics
NPI:1558723957
Name:OLIVERA, MARY-EUGENIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARY-EUGENIA
Middle Name:
Last Name:OLIVERA
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 1:9937 BOSQUE CREEK CIR
Mailing Address - Street 2:APT. 303
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5167
Mailing Address - Country:US
Mailing Address - Phone:786-253-8419
Mailing Address - Fax:
Practice Address - Street 1:9937 BOSQUE CREEK CIR
Practice Address - Street 2:APT. 303
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5167
Practice Address - Country:US
Practice Address - Phone:786-253-8419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH14646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health