Provider Demographics
NPI:1679071468
Name:MARY C OLSEN, LCSW, PSYCHOTHERAPIST, PLLC
Entity type:Organization
Organization Name:MARY C OLSEN, LCSW, PSYCHOTHERAPIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-750-9341
Mailing Address - Street 1:151 WEST 86TH STREET
Mailing Address - Street 2:SUITE 1CE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3401
Mailing Address - Country:US
Mailing Address - Phone:917-750-9341
Mailing Address - Fax:
Practice Address - Street 1:151 WEST 86TH STREET
Practice Address - Street 2:SUITE 1CE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3401
Practice Address - Country:US
Practice Address - Phone:917-750-9341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0850841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty