Provider Demographics
NPI:1760427694
Name:OLIVE, GWENN (MSW)
Entity Type:Individual
Prefix:
First Name:GWENN
Middle Name:
Last Name:OLIVE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LOCKSLEY CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6321
Mailing Address - Country:US
Mailing Address - Phone:301-384-6149
Mailing Address - Fax:
Practice Address - Street 1:6 LOCKSLEY CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6321
Practice Address - Country:US
Practice Address - Phone:301-384-6149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD064081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical