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General NPI Number Information
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NPI Number | 1790291961
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Entity Type | Individual
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Provider Name | OLIVIA BLAKE HOLDEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/23/2017
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 49 SMITH AVE
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City | MOUNT KISCO
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State | NY
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Zip | 10549-2813
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Country | US
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Telephone | 914-242-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 50 PINE TRL
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City | CARMEL
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State | NY
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Zip | 10512-5739
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Country | US
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Telephone | 914-629-8985
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 095509
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License Number State | NY
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