Provider Demographics
NPI:1619613940
Name:GORMAN, OLIVIA BRIDGET (MA, NCC, LMHC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:BRIDGET
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MA, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4357
Mailing Address - Country:US
Mailing Address - Phone:201-452-0915
Mailing Address - Fax:
Practice Address - Street 1:225 ABERDEEN DR STE C
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-7761
Practice Address - Country:US
Practice Address - Phone:219-286-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003747A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health