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

Table of content: CHERYL CHRISTINE KRANIK M.A. CCC-SLP (NPI 1336394220)

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)





Copyright © 2007-2026 www.npivalidator.com