Healthcare Provider Details

I. General information

NPI: 1124511449
Provider Name (Legal Business Name): ANNIE AMANDA OLIVIERI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 COLUMBIA TPKE STE 201A
FLORHAM PARK NJ
07932-2192
US

IV. Provider business mailing address

67 WOOD DUCK CT
HACKETTSTOWN NJ
07840-3320
US

V. Phone/Fax

Practice location:
  • Phone: 862-485-0328
  • Fax:
Mailing address:
  • Phone: 202-549-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06020100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: