Healthcare Provider Details

I. General information

NPI: 1972440014
Provider Name (Legal Business Name): STEFANIE OLIVARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E CENTER ST UNIT 1
WALLINGFORD CT
06492-5036
US

IV. Provider business mailing address

851 E CENTER ST UNIT 1
WALLINGFORD CT
06492-5036
US

V. Phone/Fax

Practice location:
  • Phone: 475-239-6021
  • Fax:
Mailing address:
  • Phone: 475-239-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: