Healthcare Provider Details

I. General information

NPI: 1891759932
Provider Name (Legal Business Name): MARY-ALICE OLSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 PERRY HWY SUITE 102
WEXFORD PA
15090-9274
US

IV. Provider business mailing address

10475 PERRY HWY SUITE 102
WEXFORD PA
15090-9274
US

V. Phone/Fax

Practice location:
  • Phone: 724-940-1730
  • Fax: 724-940-1731
Mailing address:
  • Phone: 724-940-1730
  • Fax: 724-940-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW 007582-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103305
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC
# 2
Identifier2160031
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCIGNA
# 3
Identifier425508
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK
# 4
Identifier113219
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerVALU OPTIONS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: