Provider Demographics
NPI:1629704382
Name:JONES, OLIVIA LAUREN
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LAUREN
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 PACIFIC ST APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1496
Mailing Address - Country:US
Mailing Address - Phone:203-885-2779
Mailing Address - Fax:
Practice Address - Street 1:1480 PACIFIC ST APT 2L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1496
Practice Address - Country:US
Practice Address - Phone:203-885-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health