Provider Demographics
NPI:1528728920
Name:OLITZKY, MARY T (LMHC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:T
Last Name:OLITZKY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 1ST ST NE APT 223
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3031
Mailing Address - Country:US
Mailing Address - Phone:561-531-3721
Mailing Address - Fax:
Practice Address - Street 1:4705 1ST ST NE APT 223
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3031
Practice Address - Country:US
Practice Address - Phone:561-531-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health