Provider Demographics
NPI:1861973836
Name:OLOWU, ANDIE LEE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ANDIE
Middle Name:LEE
Last Name:OLOWU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANDIE
Other - Middle Name:LEE
Other - Last Name:SOLEMINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 CUMMINGS CTR BUILDING 800 SUITE 266-T
Mailing Address - Street 2:BETH ISRAEL LAHEY HEALTH BEHAVIORAL SERVICES
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-921-1190
Mailing Address - Fax:978-922-0098
Practice Address - Street 1:85 CONSTITUTION LN STE 200A
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3630
Practice Address - Country:US
Practice Address - Phone:978-991-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X
MA218934104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)