Provider Demographics
NPI:1245313006
Name:OLIN, DENISE (PSYD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:OLIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05250-0431
Mailing Address - Country:US
Mailing Address - Phone:530-888-8037
Mailing Address - Fax:888-357-3255
Practice Address - Street 1:3938 ROUTE 7A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05250-4456
Practice Address - Country:US
Practice Address - Phone:530-888-8037
Practice Address - Fax:888-357-3255
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20480103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ847OtherMEDICARE PTAN
CAOPL204800Medicare UPIN