Healthcare Provider Details

I. General information

NPI: 1598946345
Provider Name (Legal Business Name): PATRICE D OLSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E UNION ST
HAMBURG NY
14075-5006
US

IV. Provider business mailing address

525 WASHINGTON ST
BUFFALO NY
14203-1711
US

V. Phone/Fax

Practice location:
  • Phone: 716-648-6515
  • Fax:
Mailing address:
  • Phone: 716-856-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00072646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: