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General NPI Number Information
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NPI Number | 1902306715
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Entity Type | Organization
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Legal Business Name | OLIVO THERAPY GROUP
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 290 CHESTNUT ST
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City | NEWARK
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State | NJ
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Zip | 07105
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Country | US
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Telephone | 973-545-6767
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 THIRZA PL
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City | RAHWAY
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State | NJ
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Zip | 07065-2707
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. JULIO CEASER OLIVO II
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Credential | PHD
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Telephone | 973-545-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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