Healthcare Provider Details

I. General information

NPI: 1467396069
Provider Name (Legal Business Name): OLGA LELIA PEDERSEN DMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 PIERCE ST
HOLLYWOOD FL
33021-6132
US

IV. Provider business mailing address

3102 PIERCE ST
HOLLYWOOD FL
33021-6132
US

V. Phone/Fax

Practice location:
  • Phone: 954-798-7988
  • Fax:
Mailing address:
  • Phone: 954-798-7988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: