Provider Demographics
NPI:1568600526
Name:OLESON, JOANNA R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:R
Last Name:OLESON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MAIN ST
Mailing Address - Street 2:#2
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-3306
Mailing Address - Country:US
Mailing Address - Phone:212-673-8516
Mailing Address - Fax:
Practice Address - Street 1:444 MAIN ST
Practice Address - Street 2:#2
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3306
Practice Address - Country:US
Practice Address - Phone:212-673-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017893103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist