1235295809 NPI number — MS. MIRIAM NELSON OLIVER MSW, LICSW, LMT

Table of content: MS. MIRIAM NELSON OLIVER MSW, LICSW, LMT (NPI 1235295809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235295809 NPI number — MS. MIRIAM NELSON OLIVER MSW, LICSW, LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVER
Provider First Name:
MIRIAM
Provider Middle Name:
NELSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW, LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLIVER
Provider Other First Name:
MIRIAM
Provider Other Middle Name:
NELSON
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LICSW, LMT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235295809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 OCEAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REVERE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02151-3675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-504-3838
Provider Business Mailing Address Fax Number:
781-485-6119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 OCEAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REVERE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02151-3675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-504-3838
Provider Business Practice Location Address Fax Number:
781-485-6119
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW78646 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LICSW105094 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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