Provider Demographics
NPI:1366113664
Name:WEBER, OLIVIA ROSE VELASQUEZ (LCAT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ROSE VELASQUEZ
Last Name:WEBER
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2177
Mailing Address - Country:US
Mailing Address - Phone:303-669-2790
Mailing Address - Fax:
Practice Address - Street 1:87 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2177
Practice Address - Country:US
Practice Address - Phone:303-669-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-26
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001258-01221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty