Provider Demographics
NPI:1720163942
Name:OLSON, CAROLE C (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:C
Last Name:OLSON
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 1:4 N. PINE STREET
Mailing Address - Street 2:
Mailing Address - City:NINANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357
Mailing Address - Country:US
Mailing Address - Phone:401-862-9651
Mailing Address - Fax:310-659-9217
Practice Address - Street 1:4 N. PINE STREET
Practice Address - Street 2:
Practice Address - City:NINANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357
Practice Address - Country:US
Practice Address - Phone:401-862-9651
Practice Address - Fax:310-659-9217
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3661103TC0700X
RIPS00750103TC0700X
CAPSY22829103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical