Healthcare Provider Details

I. General information

NPI: 1912440066
Provider Name (Legal Business Name): OLIVIA GIEGERICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W 58TH ST STE 313
NEW YORK NY
10019-1821
US

IV. Provider business mailing address

330 W 58TH ST STE 313
NEW YORK NY
10019-1821
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-9200
  • Fax: 212-368-5608
Mailing address:
  • Phone: 212-579-3639
  • Fax: 212-368-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number052990-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: