Provider Demographics
NPI:1063573418
Name:NEAGOE, OLIMPIA (MA CSW LLP CACI)
Entity type:Individual
Prefix:MRS
First Name:OLIMPIA
Middle Name:
Last Name:NEAGOE
Suffix:
Gender:F
Credentials:MA CSW LLP CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 APPLEWOOD LANE
Mailing Address - Street 2:BLOOMFIELD HILLS
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0569
Mailing Address - Country:US
Mailing Address - Phone:248-745-0900
Mailing Address - Fax:248-335-4680
Practice Address - Street 1:43368 WOODWARD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0569
Practice Address - Country:US
Practice Address - Phone:248-335-1130
Practice Address - Fax:248-335-4680
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101912101YA0400X
MI6301005033103T00000X
MI68010660091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF37041010Medicare ID - Type Unspecified