Provider Demographics
NPI:1336771641
Name:OLSEN, MARIA FLORENCIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FLORENCIA
Last Name:OLSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:FLORENCIA
Other - Last Name:QUIROGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:54 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4727
Mailing Address - Country:US
Mailing Address - Phone:631-356-5636
Mailing Address - Fax:
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3560
Practice Address - Country:US
Practice Address - Phone:631-446-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112015-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker