Provider Demographics
NPI:1780914739
Name:OLCSVAY, GWEN M (LCSW)
Entity type:Individual
Prefix:MS
First Name:GWEN
Middle Name:M
Last Name:OLCSVAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:M
Other - Last Name:OLCSVAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:152 ATLAS LN
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4550
Mailing Address - Country:US
Mailing Address - Phone:321-505-7053
Mailing Address - Fax:
Practice Address - Street 1:152 ATLAS LN
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4550
Practice Address - Country:US
Practice Address - Phone:321-505-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical