Healthcare Provider Details

I. General information

NPI: 1922442573
Provider Name (Legal Business Name): OLIVER LAWRENCE OLWYN LCSWR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LAWRENCE BERNARD OLWYN

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 W 148TH ST # 3E
NEW YORK NY
10031-3704
US

IV. Provider business mailing address

557 W 148TH ST # 3E
NEW YORK NY
10031-3704
US

V. Phone/Fax

Practice location:
  • Phone: 917-623-7778
  • Fax:
Mailing address:
  • Phone: 917-623-7778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: