Provider Demographics
NPI:1639911977
Name:WEYANT, OLIVIA (LCSW)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:WEYANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 ROUTE 44 STE F
Mailing Address - Street 2:
Mailing Address - City:SALT POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12578-8040
Mailing Address - Country:US
Mailing Address - Phone:845-768-3178
Mailing Address - Fax:
Practice Address - Street 1:2510 ROUTE 44 STE F
Practice Address - Street 2:
Practice Address - City:SALT POINT
Practice Address - State:NY
Practice Address - Zip Code:12578-8040
Practice Address - Country:US
Practice Address - Phone:845-768-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110495-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical