Provider Demographics
NPI:1881728863
Name:PINSLEY, OLIVIA (PHD,,LCSW)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:PINSLEY
Suffix:
Gender:F
Credentials:PHD,,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BROMPTON RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3441
Mailing Address - Country:US
Mailing Address - Phone:516-467-4267
Mailing Address - Fax:516-467-4267
Practice Address - Street 1:445 NORTHERN BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4804
Practice Address - Country:US
Practice Address - Phone:516-642-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-041584-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56-2511110OtherEMPLOYEE IDENTFICATION NO