Healthcare Provider Details

I. General information

NPI: 1427803592
Provider Name (Legal Business Name): OLIVIA BERKELEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N WESTERN AVE STE 1
CHICAGO IL
60622-6089
US

IV. Provider business mailing address

2202 W RACE AVE APT 3E
CHICAGO IL
60612-5476
US

V. Phone/Fax

Practice location:
  • Phone: 312-796-7266
  • Fax:
Mailing address:
  • Phone: 312-796-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027001
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: