Provider Demographics
NPI:1639200744
Name:OLWELL, EDWARD J (MA, LCADC, SAP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:OLWELL
Suffix:
Gender:M
Credentials:MA, LCADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 JOHN F KENNEDY BLVD
Mailing Address - Street 2:UNIT ONE
Mailing Address - City:NORTH WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-5853
Mailing Address - Country:US
Mailing Address - Phone:609-522-2183
Mailing Address - Fax:609-523-2621
Practice Address - Street 1:217 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2165
Practice Address - Country:US
Practice Address - Phone:609-463-0014
Practice Address - Fax:609-463-8671
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00098200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00098200OtherALCOHOL - DRUG COUNSELOR