Provider Demographics
NPI:1922442573
Name:OLWYN, OLIVER LAWRENCE (LCSWR)
Entity Type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:LAWRENCE
Last Name:OLWYN
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:BERNARD
Other - Last Name:OLWYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:557 W 148TH ST
Mailing Address - Street 2:# 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-3704
Mailing Address - Country:US
Mailing Address - Phone:917-623-7778
Mailing Address - Fax:
Practice Address - Street 1:557 W 148TH ST
Practice Address - Street 2:# 3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-3704
Practice Address - Country:US
Practice Address - Phone:917-623-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0811651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical