MEDICARE: MARK OLIVERAS

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
1	106H00000X	Marriage & Family Therapist	166.012230	IL

General Provider Information

NPI Number	:	1851221527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK OLIVERAS

Provider Business Mailing Address
First Line	:	2810 FRANK SCOTT PKWY W STE 812
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-5007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 FRANK SCOTT PKWY W STE 812
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-5007
Country	:	US
Telephone Number	:	888-277-4028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ MARK OLIVERAS ” Practice Location

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