Provider Demographics
NPI:1528122181
Name:OLSEN, MARYANNE (LMFT, PH D)
Entity type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LMFT, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 PLYMPTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-2114
Mailing Address - Country:US
Mailing Address - Phone:201-262-7544
Mailing Address - Fax:201-262-7579
Practice Address - Street 1:740 PLYMPTON ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-2114
Practice Address - Country:US
Practice Address - Phone:201-262-7544
Practice Address - Fax:201-262-7579
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00121500103T00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist