Provider Demographics
NPI:1871234104
Name:OLMSTED, ANICK (LCSW)
Entity Type:Individual
Prefix:
First Name:ANICK
Middle Name:
Last Name:OLMSTED
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 1:1645 UNIVERSITY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1710
Mailing Address - Country:US
Mailing Address - Phone:505-842-9911
Mailing Address - Fax:
Practice Address - Street 1:1645 UNIVERSITY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1710
Practice Address - Country:US
Practice Address - Phone:505-842-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-11411041C0700X
NMSWB-2023-13131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical