Provider Demographics
NPI:1639102908
Name:OLIN, JEANINE CAROLE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JEANINE
Middle Name:CAROLE
Last Name:OLIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:OLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:480 BROADWAY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:518-587-0268
Mailing Address - Fax:
Practice Address - Street 1:480 BROADWAY
Practice Address - Street 2:SUITE 330
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-587-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026827-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7403678OtherVALUEOPTIONS/GHI
NYJO0N47411OtherEMPIRE BCBS
NY141125000OtherMBC
NY131870OtherVALUEOPTIONS, INC
NY000470533002OtherBLUE SHIELD OF NENY
NY2728OtherSTATEWIDE PPO
NY141125000OtherMAGELLAN/AETNA
NY141125000OtherMBC