Provider Demographics
NPI:1124450002
Name:PHAN, OLIVIA MINH (PHD)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:MINH
Last Name:PHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 S 11TH ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3701
Mailing Address - Country:US
Mailing Address - Phone:267-225-7744
Mailing Address - Fax:
Practice Address - Street 1:124 S 7TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3216
Practice Address - Country:US
Practice Address - Phone:267-225-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017346103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist