Healthcare Provider Details

I. General information

NPI: 1679994354
Provider Name (Legal Business Name): CRYSTALINA OLMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2641 N 6TH ST
PHILADELPHIA PA
19133-2637
US

IV. Provider business mailing address

1216 ARCH ST
PHILADELPHIA PA
19107-2835
US

V. Phone/Fax

Practice location:
  • Phone: 215-291-6100
  • Fax:
Mailing address:
  • Phone: 215-981-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: