=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699553560
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RANDI OLIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2023
-----------------------------------------------------
Last Update Date | 09/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 WASHINGTON AVE
-----------------------------------------------------
City | GREENWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06830-5748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-862-8940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37 OLD HYDE RD
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06883-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-246-4814
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 8971
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------