Healthcare Provider Details

I. General information

NPI: 1467435362
Provider Name (Legal Business Name): RACHELLE H OLSTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ROCKROSE LN
EAST NORTHPORT NY
11731-4121
US

IV. Provider business mailing address

3 ROCKROSE LN
EAST NORTHPORT NY
11731-4121
US

V. Phone/Fax

Practice location:
  • Phone: 631-486-0833
  • Fax: 631-368-8112
Mailing address:
  • Phone: 631-368-8112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075455-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: