1578797726 NPI number — MR. PETER L OLSEN MA/LPC

Table of content: MR. PETER L OLSEN MA/LPC (NPI 1578797726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578797726 NPI number — MR. PETER L OLSEN MA/LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSEN
Provider First Name:
PETER
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA/LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578797726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2038 CARMEL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08332-9754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-825-6810
Provider Business Mailing Address Fax Number:
856-327-3320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 IRVING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08302-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-455-5555
Provider Business Practice Location Address Fax Number:
856-455-5405
Provider Enumeration Date:
05/02/2009

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: 101YP2500X , with the licence number:  37PC00237600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1447337134 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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