Basic Information
| Provider Information | |||||||||
| NPI: | 1831726041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHNKOPF | ||||||||
| FirstName: | OLIVIA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1715 PENN ST APT 2 | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171022331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093727918 | ||||||||
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| Practice Location | |||||||||
| Address1: | 99 S CAMERON ST | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171012809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172337290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2020 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.