Basic Information
| Provider Information | |||||||||
| NPI: | 1881066041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLKOWSKI-LAETZ | ||||||||
| FirstName: | MAX | ||||||||
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| Mailing Information | |||||||||
| Address1: | 542 OCEAN ST. SUITE K | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314590444 | ||||||||
| FaxNumber: | 8314590665 | ||||||||
| Practice Location | |||||||||
| Address1: | 542 OCEAN ST. SUITE K | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314590444 | ||||||||
| FaxNumber: | 8314590665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2015 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.