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General NPI Number Information
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NPI Number | 1417341595
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Entity Type | Individual
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Provider Name | OLIVIA BIDUS LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 12851 GRAND RIVER RD
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City | BRIGHTON
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State | MI
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Zip | 48116-8506
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Country | US
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Telephone | 810-227-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 6180 DENTON HILL RD
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City | FENTON
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State | MI
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Zip | 48430-9475
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Country | US
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Telephone | 586-292-2409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.015527
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | MI
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