Provider Demographics
NPI:1265624993
Name:OLSEN, VIVIAN MARTIN (LCSWC)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:MARTIN
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895
Mailing Address - Country:US
Mailing Address - Phone:301-933-7600
Mailing Address - Fax:301-933-9768
Practice Address - Street 1:3839 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895
Practice Address - Country:US
Practice Address - Phone:301-933-7600
Practice Address - Fax:301-933-9768
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13481104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker