Healthcare Provider Details

I. General information

NPI: 1780122887
Provider Name (Legal Business Name): MEGAN PAULINE OLIVERI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN PAULINE FULEKI

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 80 BOX 5217 18 MDG
APO AP
96368-5217
US

IV. Provider business mailing address

PSC 80 BOX 16092
APO AP
96367-0063
US

V. Phone/Fax

Practice location:
  • Phone: 315-634-4780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number63679
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number63679
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: