1891759932 NPI number — MS. MARY-ALICE OLSON LCSW

Table of content: MS. MARY-ALICE OLSON LCSW (NPI 1891759932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891759932 NPI number — MS. MARY-ALICE OLSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
MARY-ALICE
Provider Middle Name:
Provider Name Prefix Text:
MS.
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:
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:
1891759932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10475 PERRY HWY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090-9274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-940-1730
Provider Business Mailing Address Fax Number:
724-940-1731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10475 PERRY HWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-9274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-940-1730
Provider Business Practice Location Address Fax Number:
724-940-1731
Provider Enumeration Date:
04/14/2006

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:  CW 007582-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103305 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2160031 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 425508 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 113219 . This is a "VALU OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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