Provider Demographics
NPI:1710133285
Name:ETTS, OLIMPIA FIORE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:OLIMPIA
Middle Name:FIORE
Last Name:ETTS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 NEW FOREST CT
Mailing Address - Street 2:APT. 5
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4735
Mailing Address - Country:US
Mailing Address - Phone:917-576-7237
Mailing Address - Fax:
Practice Address - Street 1:109 LA GRANGE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9592
Practice Address - Country:US
Practice Address - Phone:917-576-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical