Provider Demographics
NPI:1679812689
Name:OLIVER, JANINE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S 31ST ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-3506
Mailing Address - Country:US
Mailing Address - Phone:484-716-2457
Mailing Address - Fax:484-716-2457
Practice Address - Street 1:4500-4510 FRANKFORD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3506
Practice Address - Country:US
Practice Address - Phone:215-831-9882
Practice Address - Fax:215-831-9887
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0157281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical