Healthcare Provider Details

I. General information

NPI: 1821902883
Provider Name (Legal Business Name): OLIVIA AGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 MAIN ST
WORCESTER MA
01603-1861
US

IV. Provider business mailing address

1280 MAIN ST
WORCESTER MA
01603-1861
US

V. Phone/Fax

Practice location:
  • Phone: 508-754-1141
  • Fax: 508-754-1115
Mailing address:
  • Phone: 508-754-1141
  • Fax: 508-754-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: