Provider Demographics
NPI:1578065272
Name:OLIVE, NELDA (BEHAVIOR ASSISTANT)
Entity Type:Individual
Prefix:
First Name:NELDA
Middle Name:
Last Name:OLIVE
Suffix:
Gender:F
Credentials:BEHAVIOR ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6967 W 25TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5458
Mailing Address - Country:US
Mailing Address - Phone:786-543-8033
Mailing Address - Fax:
Practice Address - Street 1:6967 W 25TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5458
Practice Address - Country:US
Practice Address - Phone:786-543-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty