=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255604245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN J. OLIVIERA DSW, LCSW, CASAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2012
-----------------------------------------------------
Last Update Date | 02/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 SEVENTH STREET SUITE 200
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-739-2334
-----------------------------------------------------
Fax | 516-305-4671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 233 SEVENTH STREET SUITE 200
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-739-2334
-----------------------------------------------------
Fax | 516-305-4671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LCSWR030436-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------