MEDICARE: OLIVIA CLAIRE LAKES LGSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC200002485	DC

General Provider Information

NPI Number	:	1043964133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA CLAIRE LAKES LGSW

Provider Business Mailing Address
First Line	:	272 GALLIVAN BLVD
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02124-4733
Country	:	US
Telephone Number	:	857-212-3444
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 18TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-1812
Country	:	US
Telephone Number	:	857-212-3444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	04/24/2026

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Directions to “ OLIVIA CLAIRE LAKES LGSW” Practice Location

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