Provider Demographics
NPI:1013618768
Name:OLIVER, SHELLEY ANN (LCAT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2304
Mailing Address - Country:US
Mailing Address - Phone:516-982-5749
Mailing Address - Fax:
Practice Address - Street 1:700 LAKELAND AVE STE 2D
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-3936
Practice Address - Country:US
Practice Address - Phone:631-767-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000327-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health