Provider Demographics
NPI:1770049223
Name:OLIVIERI, GEORGIANNA DALE (AMFT)
Entity type:Individual
Prefix:MS
First Name:GEORGIANNA
Middle Name:DALE
Last Name:OLIVIERI
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:MS
Other - First Name:GEORGIANNA
Other - Middle Name:DALE
Other - Last Name:OLIVIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4975 CLYBOURN AVE APT B
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4821
Mailing Address - Country:US
Mailing Address - Phone:630-346-7923
Mailing Address - Fax:
Practice Address - Street 1:4975 CLYBOURN AVE APT B
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4821
Practice Address - Country:US
Practice Address - Phone:630-346-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
CA106565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106565OtherBOARD OF BEHAVIORAL SERVICES