Provider Demographics
NPI:1154801462
Name:DERELLA, OLIVIA JULIETTE (PHD)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:JULIETTE
Last Name:DERELLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4401 BRONX BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1407
Mailing Address - Country:US
Mailing Address - Phone:718-304-7022
Mailing Address - Fax:
Practice Address - Street 1:4401 BRONX BLVD FL 1
Practice Address - Street 2:ROOM 139
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1407
Practice Address - Country:US
Practice Address - Phone:718-304-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent