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General NPI Number Information
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NPI Number | 1497571020
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Entity Type | Individual
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Provider Name | OLIVIA NICOLE BEACH LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 390 BERRY STREET FLOORS 2 & 3
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City | BROOKLYN, NEW YORK
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State | NY
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Zip | 11249
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Country | US
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Telephone | 347-505-5120
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Fax |
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Provider Business Mailing Address
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Address Line | 149 WILSON AVE APT 3R
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City | BROOKLYN
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State | NY
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Zip | 11237-3126
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Country | US
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Telephone | 908-902-1478
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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 | 125881
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License Number State | NY
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