Provider Demographics
NPI:1518635713
Name:MAZUR, OLGA JOANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:JOANNA
Last Name:MAZUR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 TRACE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-8308
Mailing Address - Country:US
Mailing Address - Phone:224-595-5056
Mailing Address - Fax:
Practice Address - Street 1:759 TRACE DR APT 204
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-8308
Practice Address - Country:US
Practice Address - Phone:224-595-5056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049.0175581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty