Provider Demographics
NPI:1174129704
Name:WHITTLE, OLIVIA JANE (LMSW)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:JANE
Last Name:WHITTLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 NOANK LEDYARD RD
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1360
Mailing Address - Country:US
Mailing Address - Phone:860-912-4331
Mailing Address - Fax:
Practice Address - Street 1:101 WATER ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5730
Practice Address - Country:US
Practice Address - Phone:860-425-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical