1861973836 NPI number — MRS. ANDIE LEE OLOWU LCSW

Table of content: MRS. ANDIE LEE OLOWU LCSW (NPI 1861973836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861973836 NPI number — MRS. ANDIE LEE OLOWU LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLOWU
Provider First Name:
ANDIE
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOLEMINA
Provider Other First Name:
ANDIE
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861973836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CUMMINGS CTR BUILDING 800 SUITE 266-T
Provider Second Line Business Mailing Address:
BETH ISRAEL LAHEY HEALTH BEHAVIORAL SERVICES
Provider Business Mailing Address City Name:
BEVERLY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-921-1190
Provider Business Mailing Address Fax Number:
978-922-0098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 CUMMINGS CTR SUITE 266-T
Provider Second Line Business Practice Location Address:
BETH ISRAEL LAHEY HEALTH BEHAVIORAL SERVICES
Provider Business Practice Location Address City Name:
BEVERLY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-921-1190
Provider Business Practice Location Address Fax Number:
978-922-0098
Provider Enumeration Date:
08/27/2018

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 218934 , 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)