Provider Demographics
NPI:1891293049
Name:OLIVO, EVELYN
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:OLIVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:377 N BROADWAY STE L2L
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2062
Mailing Address - Country:US
Mailing Address - Phone:914-308-5747
Mailing Address - Fax:
Practice Address - Street 1:377 N BROADWAY STE L2L
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2062
Practice Address - Country:US
Practice Address - Phone:914-308-5747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008456101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health