Healthcare Provider Details

I. General information

NPI: 1265340459
Provider Name (Legal Business Name): OLLIE M GILLETT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6919 CATAMARAN WAY
ARVERNE NY
11692-2033
US

IV. Provider business mailing address

6919 CATAMARAN WAY
ARVERNE NY
11692-2033
US

V. Phone/Fax

Practice location:
  • Phone: 321-277-0181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132866
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: