Provider Demographics
NPI:1891114526
Name:MICHAEL V OLIVERI
Entity Type:Organization
Organization Name:MICHAEL V OLIVERI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:OLIVERI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:636-536-7878
Mailing Address - Street 1:17300 N OUTER 40 RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1364
Mailing Address - Country:US
Mailing Address - Phone:636-536-7878
Mailing Address - Fax:636-536-7871
Practice Address - Street 1:17300 N OUTER 40 RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1364
Practice Address - Country:US
Practice Address - Phone:636-536-7878
Practice Address - Fax:636-536-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0299103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty