Provider Demographics
NPI:1720097199
Name:OLSON, PAMELA J (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:OLSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 HORNED OWL LANE
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-9519
Mailing Address - Country:US
Mailing Address - Phone:570-894-2446
Mailing Address - Fax:570-894-4511
Practice Address - Street 1:4 FORK ST STE 3080
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1209
Practice Address - Country:US
Practice Address - Phone:570-894-2446
Practice Address - Fax:570-894-4511
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0139221041C0700X
NY030439R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111740Medicare PIN