Provider Demographics
NPI:1851130942
Name:OLIVE OAK MENTAL HEALTH COUNSELING SERVICES PC
Entity type:Organization
Organization Name:OLIVE OAK MENTAL HEALTH COUNSELING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND CLINICAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:917-439-8027
Mailing Address - Street 1:669 MAIN ST UNIT 505
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7101
Mailing Address - Country:US
Mailing Address - Phone:917-438-8027
Mailing Address - Fax:
Practice Address - Street 1:669 MAIN ST UNIT 505
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7101
Practice Address - Country:US
Practice Address - Phone:917-438-8027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty