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NPI Code Detail

MEDICARE: OLIVIA BOULOS

MEDICARE: OLIVIA BOULOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker44SL07458200NJ

General Provider Information

NPI Number : 1689506115
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA BOULOS
Provider Business Mailing Address
First Line : H8 QUINCY CIR
Second Line :
City : DAYTON
State : NJ
Zip : 08810-1333
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : H8 QUINCY CIR
Second Line :
City : DAYTON
State : NJ
Zip : 08810-1333
Country : US
Telephone Number : 732-407-6559
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “ OLIVIA BOULOS ” Practice Location

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