Provider Demographics
NPI:1508473828
Name:KOMAROV, OLGA (PSYD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:KOMAROV
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:GERASIMENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1035 SAN PABLO AVENUE
Mailing Address - Street 2:OFFICE 9-1
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706
Mailing Address - Country:US
Mailing Address - Phone:510-545-6637
Mailing Address - Fax:
Practice Address - Street 1:1035 SAN PABLO AVENUE
Practice Address - Street 2:OFFICE 9-1
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706
Practice Address - Country:US
Practice Address - Phone:510-545-6637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAPSY35887103T00000X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling