Provider Demographics
NPI:1093591042
Name:VAN HAUWERMEIREN, OLIVIER (PSY D)
Entity type:Individual
Prefix:
First Name:OLIVIER
Middle Name:
Last Name:VAN HAUWERMEIREN
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 48TH AVE APT 3201
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5533
Mailing Address - Country:US
Mailing Address - Phone:917-873-6800
Mailing Address - Fax:
Practice Address - Street 1:600 3RD AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1919
Practice Address - Country:US
Practice Address - Phone:646-798-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY026872103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program