Provider Demographics
NPI:1912020884
Name:OLSON, RICHARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W BELMONT AVE
Mailing Address - Street 2:STE 211
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3200
Mailing Address - Country:US
Mailing Address - Phone:773-880-2317
Mailing Address - Fax:
Practice Address - Street 1:333 W 57TH ST APT 102
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3122
Practice Address - Country:US
Practice Address - Phone:917-685-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490121561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL469951OtherVALUEOPTIONS
IL600071671OtherMAGELLIAN
IL01636966OtherBLUECROSS BLUESHIELD
IL469951OtherVALUEOPTIONS