1184033409 NPI number — MRS. PHYLLISTINE ANNETTE OLIVER LCSW

Table of content: MRS. PHYLLISTINE ANNETTE OLIVER LCSW (NPI 1184033409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184033409 NPI number — MRS. PHYLLISTINE ANNETTE OLIVER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVER
Provider First Name:
PHYLLISTINE
Provider Middle Name:
ANNETTE
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:
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:
1184033409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 EDUCATION DR
Provider Second Line Business Mailing Address:
BEACON CITY SCHOOL DISTRICT
Provider Business Mailing Address City Name:
BEACON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12508-4067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-838-6900
Provider Business Mailing Address Fax Number:
845-838-6978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 EDUCATION DR
Provider Second Line Business Practice Location Address:
BEACON CITY SCHOOL DISTRICT
Provider Business Practice Location Address City Name:
BEACON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12508-4067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-838-6900
Provider Business Practice Location Address Fax Number:
845-838-6978
Provider Enumeration Date:
08/12/2014

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:  080303-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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