Provider Demographics
NPI:1679017735
Name:CAROLLO, OLIVIA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:LYNN
Last Name:CAROLLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4851 N CLAREMONT AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1909
Mailing Address - Country:US
Mailing Address - Phone:727-480-9038
Mailing Address - Fax:
Practice Address - Street 1:4527 N RAVENSWOOD AVE UNIT 105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5201
Practice Address - Country:US
Practice Address - Phone:312-764-1244
Practice Address - Fax:312-586-8089
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical