Provider Demographics
NPI:1962878819
Name:BREWER, OLIVIA (MS LBS)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:MS LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6534 GUYER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-2808
Mailing Address - Country:US
Mailing Address - Phone:610-653-4021
Mailing Address - Fax:
Practice Address - Street 1:700 MILAM ST STE 1300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-2736
Practice Address - Country:US
Practice Address - Phone:877-418-2978
Practice Address - Fax:866-500-2186
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician