Provider Demographics
NPI:1629856455
Name:OLIVOS, KATHRYN CELIA (RCSWI)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CELIA
Last Name:OLIVOS
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 LATREC AVE APT 1-212
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7300
Mailing Address - Country:US
Mailing Address - Phone:772-678-9390
Mailing Address - Fax:
Practice Address - Street 1:8939 LATREC AVE APT 1-212
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7300
Practice Address - Country:US
Practice Address - Phone:772-678-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL178901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical