Provider Demographics
NPI:1548250061
Name:OLCOTT, PAMELA ARLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ARLEN
Last Name:OLCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 NW 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1095
Mailing Address - Country:US
Mailing Address - Phone:352-380-3232
Mailing Address - Fax:
Practice Address - Street 1:3305 NW 53RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1095
Practice Address - Country:US
Practice Address - Phone:352-380-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0001425103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73458Medicare ID - Type UnspecifiedMEDICARE PART B