Provider Demographics
NPI:1245639400
Name:FAYERMAN, OLENA
Entity type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:FAYERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 SHORE FRONT PKWY
Mailing Address - Street 2:APT.8B
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-2154
Mailing Address - Country:US
Mailing Address - Phone:917-774-8080
Mailing Address - Fax:
Practice Address - Street 1:8200 SHORE FRONT PKWY
Practice Address - Street 2:APT.8B
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-2154
Practice Address - Country:US
Practice Address - Phone:917-774-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2604178174400000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist