Provider Demographics
NPI:1124348974
Name:OLSON, MARYLU A (LICSW)
Entity type:Individual
Prefix:
First Name:MARYLU
Middle Name:A
Last Name:OLSON
Suffix:
Gender:F
Credentials:LICSW
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:390 RIVER ST
Mailing Address - Street 2:HEALTH CARE AND REHABILITATION SERVICES OF SE VT, INC.
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4567
Mailing Address - Fax:802-886-4520
Practice Address - Street 1:51 FAIRVIEW STREET
Practice Address - Street 2:HEALTH CARE AND REHABILITATION SERVICES OF SE VT, INC.
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-254-7500
Practice Address - Fax:802-254-7501
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT351083-3501104100000X
VT089.0098673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker