Provider Demographics
NPI:1033941653
Name:SIROTNAK, OLIVIA FRANCES (LPC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:FRANCES
Last Name:SIROTNAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 GERMANTOWN AVE UNIT 18A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-4649
Mailing Address - Country:US
Mailing Address - Phone:570-335-3547
Mailing Address - Fax:
Practice Address - Street 1:1819 JFK BLVD STE 302
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1729
Practice Address - Country:US
Practice Address - Phone:610-265-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional