=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861178634
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLIVIA KRAWTCHUK LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2023
-----------------------------------------------------
Last Update Date | 06/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74 SPRING LAKE DRIVE
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-614-0449
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 74 SPRING LAKE DRIVE
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 15786
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------