Provider Demographics
NPI:1669500401
Name:OLEJNIK, THEODORE JOSEPH (LICSW)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:JOSEPH
Last Name:OLEJNIK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PARK ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2108
Mailing Address - Country:US
Mailing Address - Phone:978-495-2946
Mailing Address - Fax:
Practice Address - Street 1:208 PARK ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-2108
Practice Address - Country:US
Practice Address - Phone:978-495-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2016-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1111041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical