Active NPI
Edith Olivo, PSY.D.
- Clinical Psychologist
- Bayonne, NJ
National Provider Identifier
1548085657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 243-044
- Practice address
- 510 Broadway
Bayonne, NJ 07002-3712 - Phone
- (201) 455-2052
- NPI assigned
- Nov 22, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 243-044 | NJ | Primary |
Addresses
Primary practice location
510 Broadway
Bayonne, NJ 07002-3712
Mailing address
510 Broadway
Bayonne, NJ 07002-3712
Phone (646) 245-0925
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 243-044 | NJ | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prov 205 LLC | Current | Accepting new patients |
Locations
510 Broadway
Bayonne, NJ 07002
Phone (201) 455-2052
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Bayonne, NJ
- NPI 1063963411
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732233600000",
"number": "1548085657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 BROADWAY",
"city": "BAYONNE",
"state": "NJ",
"postal_code": "070023712",
"telephone_number": "646-245-0925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 BROADWAY",
"city": "BAYONNE",
"state": "NJ",
"postal_code": "070023712",
"telephone_number": "201-455-2052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVO",
"first_name": "EDITH",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-11-22",
"last_updated": "2024-11-22",
"certification_date": "2024-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "243-044",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayonne, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.