Provider Demographics
NPI:1881066041
Name:OLKOWSKI-LAETZ, MAX
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:OLKOWSKI-LAETZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 OCEAN ST. SUITE K
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-459-0444
Mailing Address - Fax:831-459-0665
Practice Address - Street 1:542 OCEAN ST. SUITE K
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-459-0444
Practice Address - Fax:831-459-0665
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker