Provider Demographics
NPI:1992384903
Name:OLSON, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 E 121ST ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3523
Mailing Address - Country:US
Mailing Address - Phone:212-803-3000
Mailing Address - Fax:646-335-0672
Practice Address - Street 1:198 E 121ST ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3523
Practice Address - Country:US
Practice Address - Phone:212-803-3000
Practice Address - Fax:646-335-0672
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84133-202084P0800X
NY3342102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry