Provider Demographics
NPI:1265519284
Name:OLSTER, MITCHELL F (LCSW)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:F
Last Name:OLSTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SOUTH BAY DRIVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6208
Mailing Address - Country:US
Mailing Address - Phone:516-541-9849
Mailing Address - Fax:
Practice Address - Street 1:5500 MERRICK ROAD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6208
Practice Address - Country:US
Practice Address - Phone:516-541-9849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR2875811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN70351Medicare ID - Type Unspecified