MEDICARE: DR. OLIVIA D CHAVEZ PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	071.008494	IL

General Provider Information

NPI Number	:	1467790766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVIA D CHAVEZ PSYD

Provider Business Mailing Address
First Line	:	4239 W WRIGHTWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2059
Country	:	US
Telephone Number	:	773-217-0277
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 W MONTROSE AVE STE 307
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1561
Country	:	US
Telephone Number	:	773-217-0277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2013
Last Update Date	:	12/16/2022

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