Provider Demographics
NPI:1396993721
Name:OLSEN, MIRIAM DEBORAH (BA)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:DEBORAH
Last Name:OLSEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 CINNABAR AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1854
Mailing Address - Country:US
Mailing Address - Phone:661-943-3547
Mailing Address - Fax:
Practice Address - Street 1:4544 CINNABAR AVE
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1854
Practice Address - Country:US
Practice Address - Phone:661-943-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health