Provider Demographics
NPI:1710730478
Name:LAZARUS, OLIVIA ERIN
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ERIN
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N DEARBORN ST APT 1704
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7118
Mailing Address - Country:US
Mailing Address - Phone:224-548-4705
Mailing Address - Fax:
Practice Address - Street 1:1801 W BYRON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2729
Practice Address - Country:US
Practice Address - Phone:773-244-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.112498104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker