Provider Demographics
NPI:1649780578
Name:OLIVIA CAROLLO, PSYD, PLLC
Entity type:Organization
Organization Name:OLIVIA CAROLLO, PSYD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CAROLLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-480-9038
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty