Provider Demographics
NPI:1740914589
Name:OLSEN, DEIRDRE GARLAND (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:GARLAND
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROCKHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1115
Mailing Address - Country:US
Mailing Address - Phone:516-220-2940
Mailing Address - Fax:
Practice Address - Street 1:21 ROCKHOLLOW RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1115
Practice Address - Country:US
Practice Address - Phone:516-220-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057889104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty