Provider Demographics
NPI:1609363308
Name:OLSEN, MARY C (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HAMILTON TER
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6403
Mailing Address - Country:US
Mailing Address - Phone:917-750-9341
Mailing Address - Fax:
Practice Address - Street 1:151 W 86TH ST APT 1CE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3401
Practice Address - Country:US
Practice Address - Phone:917-750-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0850841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical